Hearsay & News Review
FMLA was amended by Congress and just signed into law to
include unpaid, protected job leave for employees whose family members are
called into active duty in the military.
The law also would allow employees to take up
to 26 weeks of leave under the FMLA—up from the current 12-week annual
maximum—to take care of a child, parent or spouse who incurred an injury
during military service when that injury results in the service member being
unable to perform his or her duties. As usual Congress left regulations to the
DOL and there is a question as to when these provisions are effective. They
could be effective the day signed into law by the President, but an effective
date was not specified in the law. Typical with government, lack of detail makes
it difficult for employers to comply.
Although there is a shortage of news and studies for our
February issue, as the primaries draw to a close and candidates are selected, we
can be sure to hear much more about their health coverage proposals.
Mergers on the hospital front seem to be the other news
that will be affecting the cost of healthcare. In the
proposed a merger with Condell, but was turned down. Shortly thereafter,
Condell announced a merger plan teaming up that hospital in the Advocate system.
This would no doubt impact
negatively and they have begun advertising more heavily using their most famous
patient (Mike Ditka) as a spokesperson.
Also in the
area, Loyola has announced a merger with
’s Hospital has announced plans to buy Good Samaritan and
. Since a
is buying non-Catholic hospitals, questions are being raised as to what
services will be allowed.
when combined with such mergers/buyouts as Cigna/Great West and UHC/Fiserv, mean
there are less choices for consumers. Hospitals feel the need to band together
due to the ever increasing buying power of major insurance carriers.
The questions of transparency
in the market for health care costs continues to provide a source of irritation.
Hospitals and doctors really don’t want to publish prices. They certainly do
not want their competitors to know their prices with various managed care
vendors such as PPOs and HMOs. Consumers may want to compare prices, but
realistically, at least 9/10th of them can’t understand their
hospital bills, let alone a price list for the services. That’s not to say
that even if we could understand a price list, that the list would actually
apply. Unless the published list is a per diem, how would a hospital or doctor
set a price for an appendectomy that turned into something more? The number of
variables to be accounted for is huge. Let’s say we do nail down price, then
we have to compare price with quality. Even quality does not have an agreed upon
standard. Will quality records or malpractice records be available? It’s also
doubtful how transparent quality will get.
Let’s take it one step further. Even if all the medical
providers had transparent pricing and quality, would that mean that all managed
care companies would disclose their discounts? Just try to get up to date claims
experience and actual discounts from a Blue Cross carrier. In
, they were smart enough to pass a law so that carriers would have to disclose
the information necessary to quote to the policyholders. We’ll see about
actual enforcement. It will never happen in
or any number of states with politically appointed and weak insurance
commissioners. Many carriers hide behind HIPAA when it comes to disclosing large
claim information which includes diagnosis and prognosis. Make no bones about
it, HIPAA does allow the disclosure of that information! Carriers that
hide behind HIPAA are incorrect and technically illegal, but who is going to
fight that battle in court? It’s
even illustrated by the fact that these same carriers require the information to
quote, but do not disclose when they have the group as a client.
The people that could fight that battle on a day to day
basis are brokers and consultants who should not do business with non-disclosing
carriers on experience rated business. Frankly though, most brokers either
don’t get it, or don’t care based on the overrides (yes, carriers still pay
and other non-Eliot Spitzer states). Many brokers never had the education in
the business that allows them to understand the underwriting requirements of the
marketplace, so once they place the business, they have no leverage to move it
and their clients are stuck. By doing business on this basis, without warning
their clients of the consequences, they are just propping up the carriers even
more and giving them more power in the market. That means less choice for the
clients as more mergers take place and the carriers grow more powerful…which
leads back to hospital mergers. We understand all the rest of this well enough,
but we don’t understand the brokers and consultants who don’t know the
business well enough to not protect their client’s interests. In the end, if
this behavior is just to line their own pockets, it will backfire when the
carriers cut them out of the equation.