Dr.O’Bryan K. Hickman’s Post

Emergency medicine is a cornerstone of the healthcare system, serving as the safety net for patients in their most vulnerable moments. Yet, this vital specialty faces significant challenges—chief among them, the increasing pressure from healthcare insurers and the declining reimbursement rates that threaten the sustainability of emergency medical services. In recent years, insurer bad behaviors, such as downcoding, misinterpretation of key federal statutes, and the erosion of the physician fee schedule, have created a dangerous environment for emergency physicians and the patients they serve. https://lnkd.in/gP3GdTr3

A month ago, we discussed the alarming decline in trust in US healthcare providers—from 71.5% in April 2020 to 40.1% in January 2024. Since then, I've had insightful conversations with many of you about this critical issue. Some encouraging developments: Many hospitals are now offering price estimator tools on their websites. Certain insurance companies are simplifying their explanation of benefits. Grassroots patient advocacy groups are gaining traction in pushing for transparency. However, challenges remain. Together, we can rebuild trust and create a more patient-centered healthcare system. #HealthcareTrust #TransparencyInMedicine #PatientAdvocacy Erosion in Trust is the Real Healthcare Crisis — Capital Pulse for Medical Receivables Finance https://lnkd.in/eXgFYmXp

From the latest Becker's Hospital CFO Report ⛔ 'still has "way too many denials," with large Medicare Advantage payers driving a significant portion of these denials' ⛔ 'commercial payers have ramped up the intensity of their denial activities' Hospital are now having to come up with "denial mitigation strategies" to deal with this. This is tax payer dollars going right into the pockets of insurance companies who are coming with their own arbitrary criteria to deny care that is deemed reasonable and necessary by providers. This is an algorithm or nonclinical employee, trained on some proprietary criteria that are not based on consensus guidelines, making decisions about people's health. It is mind blowing how this type of behavior continues especially given the economic burden that healthcare has placed on everyday citizens but on the federal and state governments and a large portion of employers who provide healthcare benefits. It the economic equivalent of getting away with murder in plain sight. #healthinsurance #healthcare #cms #medicareadvantage Dutch Rojas Dean Jargo Carl C. Schuessler, Jr., DHP, DIA, GBDS Peter Hayes Stacey Richter Dave Chase, Health Rosetta-discovering archaeologist George Claassen

🚨 The Dark Side of U.S. Healthcare: Why Your Claim Was REALLY Denied 💔 Ever wondered why your perfectly valid medical claim was denied? 🤔 It’s not just a “mistake” or “miscommunication.” What if the system was designed to work against you? Let’s dive in: 🕵️♂️ Behind the Scenes of Claim Denials: 1️⃣ Profit Over Patients: For every claim denied, insurers save money. The fewer claims they pay, the more they profit. 💵 2️⃣ Delays Work for Them: They bet you’ll give up—and most people do. Only 0.2% of denied claims are appealed. (Source) 3️⃣ Complexity is the Game: Layers of paperwork, vague denial reasons, and endless back-and-forth. Sound familiar? 💡 How It Affects YOU: Patients: Delayed treatments, mounting bills, and emotional stress. 😔 Providers: Wasted time and billions in unpaid claims annually. Insurers: Growing profits while everyone else suffers. 🔥 The Big Question: Is it time to rethink a system where insurers prioritize profits over people’s health? 💬 What’s your take? Have you or someone you know faced a claim denial? Let’s talk about how we can demand a fairer, more transparent healthcare system. #HealthcareTruth #ClaimDenials #PatientCareMatters #USHealthcareCrisis #MedicalBilling #InsuranceReform #TransparencyNow

Here is an interesting article on how to fix healthcare by Dr. Paula Muto. 1. Suspend all incentives 2. Prohibit all network restrictions  3. Reward patients, not physicians or insurers 4. Expand HSAs to all age groups 5. Repeal safe harbor antikickback exemptions for pharmacy benefit managers (PBMs) and group purchasing organizations  6. Restore physician ownership 7. Restrict private equity 8. Support independent physicians 9. Anonymize patient data 10. Protect doctor-patient privacy 11. Standardize the healthcare dollar 12. Put a chip in our insurance or Medicare cards 13. Separate work from healthcare #Itilitihealth

#questionforgroup: How can monopolistic practices improve Americans' #accesstocare ( this is a real question - emphasis on affordability and high quality)? Private equity-backed physician roll-ups and joint ventures in healthcare transactions have always drawn scrutiny from state and federal regulators. The Federal Trade Commission, U.S. Department of Justice, and U.S. Department of Health and Human Services (HHS) have joined forces to make it easier for individuals to report suspicions of unfair and anticompetitive practices via a new online portal called HealthyCompetition.gov. Fair competition in healthcare forces lower prices and better quality, which includes receiving fair and just wages for healthcare service providers. This joint initiative between FTC, DOJ, and HHS will provide a crucial channel for the agencies to hear from the public, bolstering their work to check illegal business practices that harm individuals- including Medicare and Medicaid beneficiaries. Complaints submitted via the website must be specific to healthcare competition. The federal agencies will not consider complaints about failure to pay claims, questions about coverage, insurance rates, billing disputes, or general unhappiness about the healthcare system. Complaints may be anonymous, or those seeking action can include contact information. Happy reporting! #monopolisticpractices #healthcare #competition #report #faircompetition #FTC #DOJ #HHS #HealthyCompetition #Medicare #Medicaid #affordability #quality #physicianrollups #jointventures #regulators

"A significant majority of physicians (88%) said burdens associated with prior authorization were high or extremely high. This costly administrative burden pulls resources from direct patient care as medical practices complete an average of 45 prior authorizations per physician, per week." https://hubs.li/Q02N2cPR0 Let Health Prime help and say goodbye to the hassle of benefits verification and prior authorization. Continue providing exceptional care, and let us handle the rest. #medicalbilling #healthcaresolutions #virtualoffice #priorauthorization

#questionforgroup: How can monopolistic practices improve Americans' #accesstocare ( this is a realquestion - emphasis on affordability and high quality)? Private equity-backed physician roll-ups and joint ventures in healthcare transactions have always drawn scrutiny from state and federal regulators. The Federal Trade Commission, U.S. Department of Justice, and U.S. Department of Health and Human Services (HHS) have joined forces to make it easier for individuals to report suspicions of unfair and anticompetitive practices via a new online portal called HealthyCompetition.gov. Fair competition in healthcare forces lower prices and better quality, which includes receiving fair and just wages for healthcare service providers. This joint initiative between FTC, DOJ, and HHS will provide a crucial channel for the agencies to hear from the public, bolstering their work to check illegal business practices that harm individuals- including Medicare and Medicaid beneficiaries. Complaints submitted via the website must be specific to healthcare competition. The federal agencies will not consider complaints about failure to pay claims, questions about coverage, insurance rates, billing disputes, or general unhappiness about the healthcare system. Complaints may be anonymous, or those seeking action can include contact information. Happy reporting! #monopolisticpractices #healthcare #competition #report #faircompetition #FTC #DOJ #HHS #HealthyCompetition #Medicare #Medicaid #affordability #quality #physicianrollups #jointventures #regulators

PLEASE READ!!! https://lnkd.in/e4TSr9qu This latest move by Anthem Blue Cross Blue Shield to attempt to place a time limit on anesthesia billing for a given case reflects a complete lack of understanding of what happens in the operating room, not to mention another attempt by our health insurers to simply avoid paying. In fact, it would likely lead to higher medical costs. Over-billing in Anesthesia simply doesn't exist...given all the time stamps that occur throughout the perioperative process, not to mention the EMR, it would be near impossible. One would think, in light of the horrible events that occurred in New York yesterday, there might be some reconsideration of the way health insurers do business!