How would being self funded change anything? ASO plans are still headed by major insurance firms and they "rent" their network (hence network allowable amounts) to the self funded plan. Arguably insurance companies might not even have an interest in clamping down on costs since proliferation of self funded plans.
Good question. Need to be self-funded to run incentive program. Need to be self-funded to directly benefit from claims savings. Appreciate you watching. Thank you for sharing your perspective.
Can i ask a question related to the Medicare conversion factor (CF)? So say for 2024, Medicare CF is $34 and some change, and that is multiplied by the RVU of whatever the service is (CPT), is that it? The same CF for all RVU’s regardless of the category of care: imaging, surgery, OVs, psych, etc? whereas with the VA for example there are different CF’s by category of service/care that after GEO adjustments are multiplied by RVUs… is Medicare one for ALL?
Hi. Tried to share info but it got taken down (or something) 'cause the link. Here is how Medicare "allowables" (e.g. what they get paid) are calculated in the outpatient space [(RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUm x GPCIm)] x CF = Medicare Allowable
How can I educate my employees to partner with physicians who are not affiliated with these large hospital systems? Would we have to call around? I’m assuming a lot of this information isn’t easily retrievable online via some sort of consolidated database/website
Great question. Can start with insurance carrier website doctor search. Some insurance companies have that information. If not, then just have to do Google search. Look at the practice website. Should tell you if group is owned by a hospital system. Thank you for watching.
Hi Neelan, I can shed some light. This is a very manual process. Just because a provider is listed on a hospitals website doesn't mean they are part of that hospital, it could simply mean that they have privilege's at said hospital. 90% of the time you can tell if a provider is part of a hospital system because they won't have their own practice website, they will simply be listed on the hospitals site. Hospital owned physicians are large, but not as large as you would think. For example when I work on direct agreements with hospital systems, they provide a list of all providers under their TIN (tax ID number), sometimes that list is very small even for a large hospital system. Having your employees partner with physicians makes sense if you are working on direct agreements or using Reference Based Pricing, however I am not sure how conducive it would be if you are part of the BUCA's since you are renting their network anyway. At the end of the day, if you still wanted to partner directly, a Google search will suffice and review the practice website. Hope this helps.
Good question. Sage shows prices relative to Medicare rates, but not the literal dollar amount of the price. Billy shows the literal dollar amount of the price.
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Gloria sachdev another name on the national hero list along with dr bricker
Great video doc
Thank you for watching and for your kind words.
How would being self funded change anything? ASO plans are still headed by major insurance firms and they "rent" their network (hence network allowable amounts) to the self funded plan. Arguably insurance companies might not even have an interest in clamping down on costs since proliferation of self funded plans.
Good question. Need to be self-funded to run incentive program. Need to be self-funded to directly benefit from claims savings.
Appreciate you watching. Thank you for sharing your perspective.
Can i ask a question related to the Medicare conversion factor (CF)? So say for 2024, Medicare CF is $34 and some change, and that is multiplied by the RVU of whatever the service is (CPT), is that it? The same CF for all RVU’s regardless of the category of care: imaging, surgery, OVs, psych, etc? whereas with the VA for example there are different CF’s by category of service/care that after GEO adjustments are multiplied by RVUs… is Medicare one for ALL?
Hi. Tried to share info but it got taken down (or something) 'cause the link. Here is how Medicare "allowables" (e.g. what they get paid) are calculated in the outpatient space
[(RVUw x GPCIw) + (RVUpe x GPCIpe) + (RVUm x GPCIm)] x CF = Medicare Allowable
Seems same as VA, but for Medicare is the CF the same regardless of category of service?
How can I educate my employees to partner with physicians who are not affiliated with these large hospital systems? Would we have to call around? I’m assuming a lot of this information isn’t easily retrievable online via some sort of consolidated database/website
Great question. Can start with insurance carrier website doctor search. Some insurance companies have that information.
If not, then just have to do Google search. Look at the practice website. Should tell you if group is owned by a hospital system.
Thank you for watching.
Hi Neelan, I can shed some light. This is a very manual process. Just because a provider is listed on a hospitals website doesn't mean they are part of that hospital, it could simply mean that they have privilege's at said hospital. 90% of the time you can tell if a provider is part of a hospital system because they won't have their own practice website, they will simply be listed on the hospitals site. Hospital owned physicians are large, but not as large as you would think. For example when I work on direct agreements with hospital systems, they provide a list of all providers under their TIN (tax ID number), sometimes that list is very small even for a large hospital system. Having your employees partner with physicians makes sense if you are working on direct agreements or using Reference Based Pricing, however I am not sure how conducive it would be if you are part of the BUCA's since you are renting their network anyway. At the end of the day, if you still wanted to partner directly, a Google search will suffice and review the practice website. Hope this helps.
How does this compare to Billy.health price transparency tool that you also reviewed?
Good question. Sage shows prices relative to Medicare rates, but not the literal dollar amount of the price. Billy shows the literal dollar amount of the price.
@@ahealthcarez I found Billy to be all over the place. e.g. searched for a 99205 and found an allowable in the low $100s; not plausible