FRONTLINE Travels To Five Countries In Search Of a Universal Health Care System That Could Work In The U.S.

Posted by John Casillas (from the PR)

FRONTLINE teams up with T.R. Reid, a veteran foreign correspondent for The Washington Post, to find out how five other capitalist democracies--United Kingdom, Japan, Germany, Taiwan and Switzerland--deliver health care and what the United States might learn from their successes and their failures. In Sick Around the World, airing Tuesday, April 15, 2008, at 9 P.M. ET on PBS (check local listings), Reid turns up remarkable differences in how these countries handle health care--from Japan, where a night in a hospital can cost as little as $10, to Switzerland, where the president of the country tells Reid it would be a "huge scandal" if someone were to go bankrupt from medical bills.

Reid's first stop is the U.K.--a system very different from ours, where the government-run National Health Service is funded through taxes. According to Whittington Hospital CEO David Sloman, "Every single person who's born in the U.K. will use the NHS ... and none of them will be presented a bill at any point during that time." Reid is surprised to find the system often dismissed as "socialized medicine." The U.K. is now trying free-market tactics like "pay-for-performance," where some doctors are paid more if they get good results controlling chronic diseases like diabetes, and patient choice, in which hospitals compete head to head. While such initiatives have helped reduce waiting times for elective surgeries, the London Times' medical correspondent Nigel Hawkes tells Reid the NHS hasn't made enough progress. "We're now in a world in which people are much more demanding, and I think that the NHS is not very effective at delivering in that modern, market-orientated world."

Reid reports next from Japan, the world's second largest economy and the country boasting the best health statistics. The Japanese go to the doctor three times as often as Americans, have more than twice as many MRIs, use more drugs, and spend more days in the hospital, yet Japan spends about half as much per capita as the United States. Reid finds out the secrets of the nation's success: By law, everyone must buy health insurance--either through an employer or a community plan--and unlike in the U.S., insurers cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit.

Reid's journey then takes him to Germany, the country that invented the concept of a national health care system. For it's 80 million people, Germany offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, M.D., a member of the German parliament, describes it as "a system where the rich pay for the poor and where the ill are covered by the healthy. It is ... highly accepted by the population." As they do in Japan, medical providers must charge standard prices which are negotiated with the government every year. As a consequence, physicians in Germany earn between half and two-thirds as much as their U.S. counterparts.

Taiwan researched many health care systems before settling on one where the government runs the financing, but Reid finds the delivery of health care is left to the market. Taiwanese health care offers medical, dental, mental and Chinese medicine, with no waiting time and for less that half of what we pay in the United States. Every person in Taiwan has a "smart card" containing all of his or her relevant health information, and bills are paid automatically. But what Reid finds is that the Taiwanese spend too little to sustain their health care system. According to Princeton's Tsung-Mei Cheng, who advised the Taiwanese government, "As we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers."

Reid's final destination is Switzerland, a country whose health care system suffered from some America's problems until, in 1994, the country attempted a major reform. Despite a huge private insurance business, a law called LAMal was passed, which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. Today, Swiss politicians from the political right and left enthusiastically support universal health care. Pascal Couchepin, the president of the Swiss Federation, argues: "Everybody has a right to health care. ... It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."

Sick Around the World is a FRONTLINE co-production with Palfreman Film Group. The film's correspondent is T.R. Reid. The writers are Jon Palfreman and T.R. Reid. The producer and director is Jon Palfreman. FRONTLINE is produced by WGBH Boston and is broadcast nationwide on PBS. Funding for FRONTLINE is provided through the support of PBS viewers. Major funding for FRONTLINE is provided by The John D. and Catherine T. MacArthur Foundation. Additional series funding is provided by the Park Foundation. Additional funding for Sick Around the World is provided by The Colorado Health Foundation, The Commonwealth Fund and The Colorado Trust. FRONTLINE is closed-captioned for deaf and hard-of-hearing viewers and described for people who are blind or visually impaired by the Media Access Group at WGBH. FRONTLINE is a registered trademark of WGBH Educational Foundation. The senior producer is Raney Aronson. The executive producer of FRONTLINE is David Fanning.

A New Medical Banking Ecosystem

Franklin, TN (April 3, 2008) Delegates conclude a 3 day meeting today with senior officials in banking and healthcare at the 6th National Medical Banking Institute. Calling attention to natural and man-made disasters, like the subprime mortgage crisis, MBProject’s founder John Casillas asked attendees “yet today, aren’t we faced with an even more compelling man-made disaster as we experience a ground swell in the rising costs of healthcare?” He challenged attendees to rally behind medical banking as a national strategy to mitigate a “financial tsunami” that is leaving more families destitute and undercutting national productivity. He asked leaders to build a “new medical banking ecosystem” to address an impending crisis in healthcare.

Other keynotes included an industry summary by Booz Allen Hamilton, a review of data privacy issues by the Joint Commission, (which issued a new report on quality measurement and data reporting), a review of ONC efforts to build a national healthcare information network by Jodi Daniel, senior advisor at ONC, and an industry panel entitled: Are Medical Banking Systems Ready for Prime Time?”. Today’s talks will feature an industry panel (Converting “Cybercondriacs” to HIT Wizards”) moderated by David Harris, a partner at PricewaterhouseCoopers who chairs the HSA Workgroup at MBProject. The panel features Microsoft HealthVault program, a personal healthcare record service, Best Doctors and OptumHealthBank. Dr. Paul Grundy from IBM, who chairs the Patient Centered Primary Care Collaborative, will introduce bank delegates to the new Medical Home concept and seek their participation to change the healthcare payment systems.

A series of new industry announcements by MBProject Members were announced during the day, including:

• Fifth Third Bank announced a new partnership with GHN-Online and Revenue Management Solutions (RMS) to launch a new business intelligence platform for the healthcare industry.
• GHN-Online released a new healthcare reimbursement scorecard that measures “the average number of payment days for a clean claim from payors, extracted from the payors remittance advice reports.” The firm further announced a new relationship with Revenue Managements Solutions (RMS) to provide a “comprehensive claims processing and remittance solution for healthcare banking.”
• E-Duction announced that it has now processed over 1,000,000 “variable payroll deductions” using a “guaranteed issue credit, zero percent interest and automatic payment via payroll deductions that traditional credit cards don’t offer”. In a separate announcement, the firm announced that an independent market research firm rated users of the program and found that 81% are “highly satisfied”.
• The Bank of New York Mellon and The SSI Group, Inc., announced a new healthcare services alliance that will “enhance a range of end-to-end claims processing solutions” for healthcare clients. This includes “new lockbox services for patient and commercial insurance payments, conversion of paper transactions to electronic remittance advices (ERAs), establishment of ERAs and reassociation of ERAs with electronic payments, providing the industry an all-payer solution.”
• The Bancorp Bank announced that it is “aggressively pursuing a variety of strategies” in healthcare through 120 established relationships with a variety of clients nationwide; and listed its bank as one of the “Top 50” Origination Depository Financial Institutions (ODFIs) and one of the “Top 5” HSA Administrators in the nation.
• PNC announced that it is the first bank in the nation to receive EHNAC accreditation for its health care clearinghouse, lockbox and e-commerce operations. PNC was noted for its “extremely robust systems, policies and procedures” and a data center and disaster recovery documentation that was cited as “the best ever seen” by the independent site consultant.
• TransUnion announced a new patent for its Healthcare Revenue Cycle Platform (HRCP), “an ASP-based technology platform that determines, in real time, patient eligibility for financial assistance at point of registration.” Among other functions, the platform “pursues multiple financial assistance opportunities concurrently, providing significant labor savings to hospitals; reducing staff time spent gathering data and filing forms.”

A main focus of the Institute was on emerging privacy and security frameworks. MBProject announced a new medical banking “Gold Seal” standard “that instills public trust” among medical banking constituencies, “a key cornerstone for a new medical banking ecosystem”. A pilot program conducted by the Working Capital Solutions division of the Bank of New York Mellon and Milliman was previously announced. An afternoon session reported out industry results to attendees.

The complete press releases will be posted on the Institute Agenda at www.mbproject.org by April 11, 2008.

About the Medical Banking Project...
MBProject is a pioneering authority that coined the term “medical banking™” to denote the emerging global convergence of banking and healthcare systems to improve health costs, quality and access. Our educational forums, workgroups and pilot programs showcase visionary ideas and initiatives that inform policy, commerce and academia. Supported by a diverse constituency, MBProject conducts research and outreach that defines and facilitates medical banking™, and this supports our mission to convert digital savings into charitable resources. Our work demonstrates how banks can improve healthcare programs for consumers, care givers, health plans and employers. For more information please go to http://www.mbproject.org or contact Evelyn Marquez Sanchez, 615-794-2009,
[email protected]

Overview of Players and Their Roles in the Emerging Medical Banking Industry

Note: I'm not able to attend the MBI this year but I'm going to blog from notes on the hope that this will still be of value to the MBlog readership. - ED

Presenter: Doug Bilbrey, EVP, The SSI GROUP, Inc., Mobile, AL, 800-880-3032, [email protected]

During the Medical Banking Boot Camp, Doug's presentation discussed the Players in the Medical Banking field: Providers (Institutional, Professional, Ambulatory Care Centers), Payers (Commercial, Governmental, Fiscal Agents), Vendors (HIS, PMS, RIS/PACS; EDI; Analytical / Revenue Recovery; Document Management {OCR/ICR}; Decision Support {Financial, Clinical}; Clinical Systems; Adjudication Systems), Trade Associations (HIMSS, HBMA, RBMA, MGMA, HFMA, RSNA, ECT...; Cooperative Exchange ), Collections Companies (NCO, Chamberlain Edmonds, Regional / Local ), Consultants, Banks (Consumer, Commercial), Employers, Politicians, Government, Consumers

Discussing the The Bad and The Ugly of Healthcare Fiscal Management, Doug noted:

• $300 billion of collected funds goes to processing bills, claims and payments; bad debt; and other transactions each year.
• 60% of claims paid are paper, average cost of $8 each
• Approximately 1 in 5 claims submitted is delayed or denied
  • 96% must be submitted more than once!
• Bad debt expense ranges between $40 to $60 billion
  • 80-90% of consumer self-payments goes uncollected
  • on average, 50% of commercial payments

Further, he pointed out that 14 percent of all claims submitted to payers are denied and that this is important when one considers that denials represent 11 percent of a provider’s gross charges.

On "Why Do Claims Get Denied?" he reported:

Coordination of benefits	25%
Patient not eligible	15%
No authorization	5%
Medical Record requested	11%
Untimely filing	11%
Additional info pending	9%
Non-covered Service	7%
Benefits expired	6%
Billing Errors	1%
Contract Review	.03%

Regarding the Cost of Collections, he listed these factors: Patient Balances, Statement Generation/Processing, A/R Aging, Small Balance Write-offs, and Unbilled or Missed Charges

Among Industry Pressures on Providers, he cited: Reimbursement from Payers (CMS, Commercial), Higher Deductibles, Philosophical/Cultural (“We’re here to take care of sick people”), Requirements Complexities (Coding, Billing, Collections and follow-up), Human Resources (Finding them, Keeping them, Incentives ), Legal (Liability), Outpatient Centers (Highly compensated services, Hospitals left holding the bag), Infrastructure (Physical Plant, Technology), and  Community Perception

Industry Pressures on Payers faced include: Operational Costs (FTE’s, Payments), Inefficient Processing Mechanisms (Telephonic, Paper), Membership Satisfaction, Community Demands (On-line access, PHR, Provider Tools, and Integrated Delivery Systems)

Industry Pressures on Employers relate to: Costs (Company, Employee, Dependants), Employee Retention, Employee Recruitment, and Enrollment

While Industry Pressures on Consumers comes from all of the above as well as Access to Healthcare, Affordability, and Bombardment of R/X Ads (Do I have this? Should I take this? What are the consequences?)

Meanwhile Political Pressures will focus on Election 2008 (The Economy, Cost of Living {Fuel Costs, Inflation}), Access to Healthcare (Real or Perceived); Fallout (What new pressures will be levied on system? {Fixed Prices?, Additional/Stricter Requirements?}, Who Pays for This?)

Solutions need to recognize Patient Access/The Genesis of The Claim and the Potential Impact

Patient Access is Key since 45 – 55 Percent of all billing errors originate in Patient Access, Patient Access has one of the highest levels of turnover within a provider organization due in part to the Tremendous Pressure placed of Patient Access Staff (Consent Forms, Benefit Verification, Copay and Deductible Collection, Advanced Beneficiary Notice, Advanced Directive and "Do all this in 10 minutes or less") Improved Processes can affect outcome for Patients, Providers, Payers and the Entire System

How Might Banks Help?

Trusted Delivery Mechanisms (PHR, Financial Transactions, Infrastructure); Connections between Payers, Providers, and other Banks; LockBox (Remits, Claims ???, Eligibility Rosters ???) Banks Are Uniquely Positioned (Patient Access {Credit Card Processing, Upfront Collections of Co-Pay and Deductibles}, Claim Processing {Value Added Services [Clearinghouses, Claim Warehousing, Data Archival]}; Remittances (ERAs, Lock Box {Paper to ERA}, All Payer Capabilities), and Providers Need and Will Use These Services