artdiamondblog.com – Page 629 – Art Diamond's web log

Doctor Overhead Increased 15 – 20% Due to Insurance Delays in Paying Claims

Source of the graphic: the online version of the NYT article cited below.

What is noteworthy in the table above is not the differences in delays in paying. What is noteworthy is that the fastest payer still takes a month to pay.

(p. C1) Few things rankle a doctor more than an insurance company’s saying it cannot find a claim for medical services. Particularly when there is even a signed return receipt to document delivery of the bill.

"We actually had the little green card to show who signed for the dang thing," said Elizabeth Wertz, chief executive of the Pediatric Alliance, a large group of Pittsburgh doctors. "We sent it by certified mail. The insurance company said they didn’t have it."

The claim was for several thousand dollars, according to Ms. Wertz, who declined to identify the company, a large regional insurer, for fear of making it more difficult to wrangle payments. It is a problem known to many doctors as they struggle to balance the rising cost of providing patient care with what they see as a reluctance by some powerful insurers to pay promptly.

Pediatric Alliance’s 37 doctors are among the 7,000 physicians, nurse practitioners and other health care providers around the country who are clients of the claims-processing company Athenahealth, which plans today to present a rare warts-and-all look at how well — or not — the nation’s seven biggest health insurers pay their bills.

Not well enough, in many cases, according to the data and to experts who say the survey provides the most comprehensive look yet at the state of accounts payable vs. accounts receivable in the nation’s health care system.

Tardiness or refusal to pay what doctors consider legitimate medical claims may add as much as 15 to 20 percent in overhead costs for physicians, forcing them to pursue those claims or pass along the costs to other patients, according to Jack Lewin, a family doctor who is chief executive of the California Medical Association, a professional group of 35,000 physicians.

. . .

(p. C10) Athenahealth, which says it collected $1.8 billion on behalf of its physician clients last year, is among the biggest of several thousand companies that help doctors and hospitals get paid by editing their claims and helping them to deal with difficult cases. Health care providers who can afford such services say they have become a necessary part of doing business.

In the case of Pediatric Alliance, with 37 pediatricians in a dozen offices in and around Pittsburgh, the doctors’ group spends at least $250,000 a year on salaries for eight billing clerks who handle claims and pursue money owed by insurers and patients. That is on top of salaries in Pediatric Alliance’s offices for staff members to verify the patient’s coverage and collect co-payments, plus paying an outside company to check for errors before the bills go out.

Ms. Wertz, the alliance’s chief executive, says some insurers’ telephone call centers limit claims-related issues to 10 per call. "That’s incredibly inefficient," she said. "We see thousands of patients. Our people have to sit on phone 30 minutes to get a live person."

. . .

"I would much rather have my staff talking to patients than talking to insurance companies," Dr. Katz said.

For the full story, see:

MILT FREUDENHEIM. "The Check Is Not in the Mail." The New York Times (Thurs., May 25, 2006): C1 & C6.

(Note: The "Dr. Katz" mentioned is "Dr. Molly Katz, a Cincinnati gynecologist and former president of the Ohio Medical Association.")

U.S. Government “spending $3,500 to find out if we handled $1 correctly”

Indian records buried in a limestone cave near Lenexa, Kansas. The Omaha-World Herald identifies the unhappy gentleman as "Ross Swimmer, a special assistant with the Interieor Department" (see source cited for excerpt below). The Olympian Online of Olympia, Washington identifies him as "John Allshouse, assistant regional administrator for the National Archives" (see source cited for image). Source of image: http://159.54.227.3/apps/pbcs.dll/article?AID=/20060507/NEWS/60507029

LENEXA, Kan. (AP) – Seventy feet beneath the prairie, the government is filling limestone caverns – protected by guards and a bomb-sniffing dog – with truckloads of American Indians’ financial and cultural records.

What is ground zero for an accounting that will take seven years and cost $335 million owes its existence to a bitter class-action lawsuit brought against the Interior Department a decade ago. Still, it’s only a short version of the historical accounting that Indians demanded but no longer want, because they do not think it can be done properly.

The Indians say the government mismanaged a trust in their names for 120 years and now owes them tens of billions of dollars.

. . .

Concerns about the how the trust accounts are managed are almost as old as the trust itself.

In 1915, the Joint Commission of Congress on Indian Funds warned of "fraud, corruption and institutional incompetence almost beyond the possibility of comprehension." In 1928, the Interior Department found Indian trust data unreliable and almost useless. Dozens of other scathing reports followed.

Finally, in 1994, Congress demanded that the department fulfill an obligation to account for money received and disbursed. A year later when account statements still had not been reconciled, Elouise Cobell of the Blackfeet Indian tribe in Montana joined with the Boulder, Colo.-based Native American Rights Fund and others in suing.

"Fractionalization" of accounts is a major obstacle in managing the trust. As ownership of the 160-acre and smaller land parcels transferred from generation to generation, proceeds from the trust accounts had to be divided among more and more descendants. Department officials say 90 percent of the transactions are for less than $100.

"In every category it has cost us more to find the errors than the total amount of the errors we found," said departing Interior Secretary Gale Norton. "When you consider that we have millions of transactions under $1, you’re spending $3,500 to find out if we handled $1 correctly."

For the full story see:

"Paper Trail Fills Massive Cave." Omaha World-Herald (Sun., May 21, 2006): 10A.

(Note, the online version, has a different title and a day-earlier publication date:

"Counting Up What Indians Are Owed." Omaha World-Hearald (Sat., May 20, 2006).)

Leonard Read’s Comparative Advantage

When I was a student at Wabash College, Ben Rogge arranged for Liberty Fund to finance my attendance at a couple of weekend seminars at the Foundation for Economic Education in New York. The seminars were taught by Rogge, Edmund Opitz, and Leonard Read. I remember upon returning to Wabash after one of the seminars, Rogge asking me what I thought of Read. I said something along the lines that I didn’t much like his presentation style. I remember saying that he expressed himself in a way that I associated with used car salesmen. (So unlike Rogge’s low-key, witty, intensity.)

My memory is that Rogge did not respond directly to my comment, but (perhaps with a hint of a smile) mentioned that among many audiences, especially in business, Leonard Read was an extremely effective speaker.

I do not doubt that, and I also do not doubt that Read belongs in the pantheon of free market defenders. His essay "I, Pencil" is by itself sufficient for admission. But he did more than write and speak; he nurtured and called attention to others who had wisdom to offer. For one small example, many of us learned about Albert Jay Nock’s "The Remnant" through Leonard Read’s The Freeman.

I believe that the last time I saw Read was at the memorial service at Wabash College for Ben Rogge. I ended up sitting near Read and Opitz, who had flown in from New York. I introduced myself as a Rogge student who had attended FEE seminars.

I remember Read looking very sad, and depressed, and almost lost. I also remember that he expressed some mild indignation that more of Rogge’s students hadn’t made it back for the memorial service.

But as a serious reader of "The Remnant," Read on further reflection probably realized that the attendance at a memorial service is not a good measure of a teacher’s influence on his students.

Apparently one student, whom Read himself influenced, was Charles Koch:

(p. A8) Whereas the bookshelves of most of America’s leading CEOs are stocked with pop corporate management and "how to succeed" books, Mr. Koch’s office is a wall-to-wall shrine to writings in classical economics, or, as he calls it, "the science of liberty." The authors who have had the most profound influence on his own political philosophy include F.A. Hayek, Ludwig von Mises, Joseph Schumpeter, Julian Simon, Paul Johnson and Charles Murray. Mr. Koch says that he experienced an intellectual epiphany in the early 1960s, when he attended a conference on free-market capitalism hosted by the late, great Leonard Read.

For the full commentary, see:

STEPHEN MOORE. "THE WEEKEND INTERVIEW with Charles Koch; Private Enterprise." The Wall Street Journal (Sat., May 6, 2006): A8.

(Note: In the quotation above, I have corrected the WSJ’s misspelling of Read’s last name.)

United States Exports More Services, than it Imports (a.k.a. “Outsources”)

This month a poll by Zogby International for the Foreign Policy Association found that 71 percent of Americans believed outsourcing was hurting the economy. It also found that 62 percent of American workers believed the federal government should penalize companies that send work offshore.

Now, however, we can add some actual figures to the overheated debate. The Government Accountability Office has issued its first review of the data, and one undeniable conclusion to be drawn from it is that outsourcing is not quite the job-destroying tsunami it’s been made out to be. Of the 1.5 million jobs lost last year in ”mass layoffs” — that is, when 50 or more workers are let go at once — less than 1 percent were attributed to overseas relocation; that was a decline from the previous year.

. . .

The data did show that from 1997 to 2002, annual imports of business, technical and professional services increased by $16.3 billion. However, during that same half-decade, exports of those services increased by $20.5 billion a year. In 2002 alone, the United States ran a $27 billion trade surplus in business services, the sector in which jobs are most likely to be outsourced. The G.A.O. correctly stressed that it is impossible to compute exactly how many jobs are lost because of outsourcing, but unless its figures are off by several orders of magnitude, there’s no crisis here.

For the full commentary, see:

Daniel W. Drezner. "Where Did All the Jobs Go? Nowhere." The New York Times (Weds., September 29, 2004): A25.

Paperwork is 31% of U.S. Health Care Costs

. . . , a large part of America’s health care spending goes into paperwork. A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.

For the full commentary, see:

PAUL KRUGMAN. "The Medical Money Pit." The New York Times (Friday, April 15, 2005): A19.

Canada may beat the U.S. in this dimension of health care, but they lose in many other important dimensions–for example the wait time to receive ‘elective’ surgeries. And anyway, isn’t 17 percent still too high?

Free Market Philanthropy

Charles Koch. Source of image: online version of WSJ article cited below.

Mr. Koch’s latest crusade to spread the ideas of liberty has been his sponsorship of a twice-yearly conference that gathers together many of the most successful American entrepreneurs, from T. Boone Pickens to former Circuit City CEO Rick Sharp. The objective is to encourage these captains of industry to help fund free-market groups devoted to protecting the fragile infrastructure of liberty. That task seems especially critical given that so many of the global superrich, like George Soros and Warren Buffett, finance institutions that undermine the very system of capitalism that made their success possible. Isn’t this just the usual rich liberal guilt, I ask. "No," he says, "I think they simply haven’t been sufficiently exposed to the ideas of liberty."

For the full commentary, see:

STEPHEN MOORE. "THE WEEKEND INTERVIEW with Charles Koch; Private Enterprise." The Wall Street Journal (Sat., May 6, 2006): A8.

“Everybody wants to be like Bill Gates”

Vietnamese university students hoping to see Bill Gates. Source of image: http://www.nytimes.com/2006/04/27/world/asia/27vietnam.html?ex=1303790400&en=255d4d4996b1a9a6&ei=5088&partner=rssnyt&emc=rss

HANOI, Vietnam, April 26 — It was Lenin’s birthday. The most important Communist Party meeting in five years was under way. And the star of the show was the world’s most famous capitalist, Bill Gates.

The president, the prime minister and the deputy prime minister all excused themselves from the party meeting on Saturday to have their pictures taken with Mr. Gates, who has more star power in Vietnam than any of them.

When people heard he was in town, hundreds climbed trees and pushed through police lines to get a glimpse of him. He was the subject of the lead article in the next day’s newspapers.

This is where Vietnam stands today, moving cautiously toward a new version of communism while the people and their leaders lunge eagerly for the brass ring of capitalist development.

"That was very symbolic," said Le Dang Doanh, an official in the Ministry of Planning, speaking of the reception for Mr. Gates. "It is a very clear sign of the new mood of society and the people. Everybody wants to be like Bill Gates."

For the full story, see:

SETH MYDANS. "Communist Vietnam Lunges for Capitalism’s Brass Ring." The New York Times (Thurs., April 27, 2006): A3.

Note: the version of the article above corrects an error in the print version that had misidentified the day of Lenin’s birth, and Gates visit as a Sunday (it was a Saturday).

Reagan on the Bureau of Indian Affairs

Source of book image: http://www.amazon.com/gp/product/0060957573/ref=ed_oe_p/104-5180402-9681554?%5Fencoding=UTF8

Michael Deaver, longtime aide to Ronald Reagan, has written an interesting memoir that documents that in most important respects, Reagan was his own boss, worked hard, and had a focused intellect.

He also documents what most grant: Reagan was a great communicator. One element in his success as a communicator is illustrated below:

(p. 71) . . . he would often recount a fictitious yarn of a sobbing bureaucrat he encountered at the Bureau of Indian Affairs. The man was at his desk, crying into his folded arms when Reagan touched him on the shoulder and asked him what was wrong. "My Indian died, that’s what’s wrong," came the response. "What the hell am I supposed to do now?"

The citation for Deaver’s book is:

Deaver, Michael K. A Different Drummer: My Thirty Years with Ronald Reagan. Reprint ed: Harper Paperbacks, 2003.

Spontaneous Order in Cockroaches

Even cockroaches manage to make collective decisions that, seemingly by magic, produce an outcome that benefits everyone (except the people whose kitchens they are in). When roaches decide where to move in, they must balance crowding against protection against predators. The goal: pack enough roaches into a shelter to provide strength in numbers, but not so much that dangerous crowding results.

When scientists put roaches into a dish containing identical shelters, they thought the roaches would fill one shelter and then use others for spillover. But the gregarious bugs defied expectations.

When more than half the bugs could fit into one shelter, they divided into two equal groups: For instance, when 50 had a choice of three shelters, each with a capacity of 40, 25 cockroaches gathered in one, 25 in another, and none in the third, biologist José Halloy of the Free University of Brussels and colleagues reported last month in Proceedings of the National Academy of Sciences.

Dividing up evenly, he says, "spreads benefits and risks among all individuals," rather than having 40 bugs safe and happy while the 10 for whom there was no room at the inn suffer. But when each of three shelters could hold 70, all 50 cockroaches packed into one. Each outcome was optimal, producing the greatest safety in numbers without crowding.

Yet no leader assigns lodging. Roaches just check out shelters, with later arrivals deciding that a crowd signifies "this is the place to be." Overcrowding means "find somewhere else." A group decision that perfectly balances protection and crowding emerges from dozens of such individual decisions.

For the full story, see:

Begley, Sharon. "Buffalo Seek Consensus and Other Tales of How Animals Decide Things." The Wall Street Journal (Fri., April 14, 2006): A11.

Kenyan Lawmakers Nearly Double Their Mercedes Mileage Allowances: More on Why Africa is Poor

The relatively modest vehicle of Francis Ole Kaparo, the speaker of Kenya’s National Assembly, contrasts with other Kenyan lawmakers’ "Mercedeses, Land Rovers and other typically sleek rides." Source of photo: the online version of the NYT article cited below.

NAIROBI, Kenya, May 21 — It has been a trying year in Kenya, one of the worst in decades, as a severe drought killed off crops and cattle and left millions with empty stomachs and uncertain futures.

In such suffering, members of Parliament have been roused to action as seldom before, finding common ground on an issue so pressing that they threatened to stonewall the budget until it was addressed: another big increase in their compensation.

The move last month to reward themselves in a time of crisis infuriated Kenyan voters, most of whom eke out a living on a fraction of what their elected officials earn. It also reinforced the notion that this was a political drought, one that owed its origins as much to mismanagement in a country that should be able to feed itself as to the vagaries of nature.

. . .

. . . , some say legislators have lost touch with the poor districts they represent. Per capita income is about $463 a year, which nobody here would expect a lawmaker to survive on. Minimum wage is $924 a year, still far too little, in most Kenyans’ view, for someone taking care of the nation’s business.

But the base compensation that legislators earn is about $81,000 a year, tax free, plus a variety of allowances and perks, which can effectively double their take-home pay. That means those public servants earn more than most Kenyan corporate executives and outstrip the salaries of many of their counterparts in the developed world.

"They are behaving like we are rich and as if there’s no famine and poverty in the country," Maina Kiai, the chairman of the Kenya National Commission of Human Rights, complained recently to the newspaper The Daily Nation. "They want to make as much money as they can."

The latest increase, which cost the country $2.78 million, nearly doubled the mileage allowances that lawmakers receive for their Mercedeses, Land Rovers and other typically sleek rides.

For the full story, see:

MARC LACEY. "Nairobi Journal; Crisis Swirls in Kenya, and Politicians Reward Themselves." The New York Times (Mon., May 22, 2006):

Hunter-Gatherers Prefer Civilization

Source of photo: online version of NYT article cited below.

(p. A13) The newly arrived Nukak do not provide much detail about why they left. They just say that "the Green Nukak," a possible reference to Marxist guerrillas, who wear camouflage, told them to leave.

"The Green Nukak said we could not keep walking in the jungle, or else there would be problems," explained Va-di, another Nukak man, whose words were translated from Nukak by Belisario. "The Green Nukak told us to go where it is safe."

. . .

In Aguabonita, the scene on a recent day was full of commotion and laughter. Naked children tugged at the shirts of two foreign journalists, offering big smiles and hugs. The men quickly welcomed the visitors into a makeshift shelter, where they laughed at some of the questions and, it seemed, wholly innocently at their own odd predicament.

Are they sad? "No!" cried a Nukak named Pia-pe, to howls of laughter. In fact, the Nukak said they could not be happier. Used to long marches in search of food, they are amazed that strangers would bring them sustenance — free.

What do they like most? "Pots, pants, shoes, caps," said Mau-ro, a young man who went to a shelter to speak to two visitors.

Ma-be added, "Rice, sugar, oil, flour." Others said they loved skillets. Also high on the list were eggs and onions, matches and soap and certain other of life’s necessities.

"I like the women very much," Pia-pe said, to raucous laughs.

One young Nukak mother, Bachanede, breast-feeding her infant as she talked, said she was happy just to stay still. "When you walk in the jungle," she said, "your feet hurt a lot."

The men still go into the jungle, searching for monkeys, a delicacy the Nukak cannot seem to live without. Monkeys are grilled, dismembered and boiled, then eaten piece by piece. The women still spend their time carefully weaving intricate wristbands and hammocks, using threads from palm leaves.

All live in shelters now, enjoy constant medical attention and, on weekends, stroll into town to take in the sights. "Nukak life is hard in the jungle," Dr. Maldonado said. "You wake up thinking about food and you go hunt, you go search for nuts. So when they see us they think their food problems are over."

That is not to say the Nukak do not have plans.

Ma-be explained that the idea is to grow plantains and yucca and take the crops to town. "We can exchange it for money," he said, "and exchange the money for other things." But first they need to learn how to cultivate crops. The Nukak say they would like their children to go to school. They also say they do not want to lose traditions, like hunting or speaking their language. "We do want to join the white family," Pia-pe said, speaking of Colombian society, "but we do not want to forget words of the Nukak."

For the full story, see:

JUAN FORERO. "Leaving the Wild, and Rather Liking the Change." The New York Times (Thurs., May 11, 2006): A1 & A13.

(Note: ellipsis added.)