Don't overlook impact of consumer-driven healthcare, and other letters

Regarding the recent Comment/Guest Expert, “Higher employee cost-sharing could undermine job-based coverage system” (Modern Healthcare, June 8, p. 25), the Commonwealth Fund's Dr. David Blumenthal addressed many salient facts and issues relating to employer-based health insurance in his editorial.

While he is spot on in his assessments on many fronts, he neglected to discuss consumer-driven healthcare and the impact it has on healthcare cost-sharing among employers. Employers are shifting costs, in part, to create incentives for their employees to engage in value-based decisionmaking. To support that, they are investing heavily in strategies and tools to inform employees' decisions. And although the Affordable Care Act now mandates full coverage for preventive services, many employers already offered it.

America's leading companies have been instrumental in driving policy aimed at improved transparency, outcomes and value-based healthcare. Many of the nation's largest corporations have implemented benefit designs and healthcare programs that move the market. For instance, some employers do select contracting for common and expensive procedures such as hip and knee replacement and spine surgery for better quality and savings, including savings for employees.

It helps everyone—employers and their covered members—to do business with value-based, outcomes-driven healthcare providers.

Many would conclude that some of the cost-reductions Dr. Blumenthal references are attributable to consumer-driven health plans. That said, employers do not think it's good ethics or sound business to cause undue financial burden for employees and they recognize they need to—either directly or in concert with health plans—reduce the overall cost arc of healthcare.

Lauren Vela

Senior director of member servicesPacific Business Group on HealthSan Francisco

Regarding the recent article “Hospitals rake in $1.3 billion from Medicare appeals settlements” (Modern-Healthcare.com, June 12), I take issue with the statement from one of the sources saying that providers “game the system by appealing every claim denial, bring the appeals system to a standstill and then be paid regardless of the outcome of their case. This essentially incentivizes hospitals to continue to overwhelm the system with frivolous appeals.”

Anyone who has spent time on the receiving end of the recovery audit contractors would never make such an unfounded and uninformed statement. It is not the providers gaming the system—we are taking care of beneficiaries and only trying to get reimbursement for care provided. It is not part of our business plan to place hundreds of thousands of dollars in limbo (remember, the money is taken back) while the backlogged appeals process churns ever slower. Hospitals have spent valuable resources (money and personnel) fighting these take-backs. Nobody would make such an approach the basis for a hospital's income strategy.

Also, the headline that hospitals are “raking in $1.3 billion” is deceptive. What about the billions providers haven't recouped and the millions they spend defending themselves?

Michelle McAdoo, RN

RAC coordinator/denials managementPardee UNC Health CareHendersonville, N.C.

Regarding the recent Vital Signs blog, “New AMA leader rejects growing movement to regulate out-of-network doc bills” (ModernHealthcare.com, June 14), as a physician, I agree with new American Medical Association President Dr. Steven Stack on many issues, but strongly disagree with him on this one.

I have learned in Texas that emergency room docs and hospitals can both make more money by having out-of-network doctors at in-network hospitals. If there is not further “incentive” to resolve this issue, it will not happen. Surprise medical bills in ERs are unfair to patients.

Dr. Robert Luedecke

San Antonio