Saturday, July 25, 2009

MGMA Health Care Consulting Group & Carle Clinic (Urbana Illinois)

Some creepy medical clinics like Carle Clinic in Urbana, Illinois, are actually requiring that patients make a prepayment before "non-emergency procedures." My question is whether the orthopedics department at Carle Clinic (specifically Chris Dangles, M.D.) requires partial prepayment for surgeries when the surgeon does not know why he is performing the surgery. Hmm. How about that, Dr. Dangles? Oh I understand ...

Physicians and surgeons who are motivated by money (with all due apologies to ENT surgeons) and unaffected by the harm they cause the patients do precisely what Obama Care envisions . . . enlarge the distance between the patient and the physician.


Enter the likes of Ken Hertz with the MGMA Health Care Consulting Group. According to MGMA Health Care Consulting Group's Ken Hertz, insured patients must be "re calibrated" to stop expecting insurance to pay bills. Nice. How about expecting doctors to perform only necessary surgeries?

http://www.news-gazette.com/news/local/2008/11/21/need_surgery_carle_clinic_will_need_a_down_payment_first

URBANA – Whether it's your aching knee or your tonsils about to go under the knife, you may not see the surgeon these days unless your wallet appears first.
Carle Clinic has joined a growing number of physician groups now requiring patients to pay a deposit in advance of all non-emergency surgeries.
The policy, which excludes obstetrics and gynecology procedures, went into effect earlier this month, and so far, a clinic official said, most patients haven't complained.
"We've collected very easily a significant number of deposits," said Carla Kurtz, Carle Clinic's director of surgery services. "We have heard from people who thanked us for calling ahead and letting them know about this new policy, because they've brought their checkbook or credit cards with them."
Carle Clinic's new pay-ahead policy applies to all non-emergency procedures – defined as those performed for non-life-threatening conditions – performed by Carle Clinic doctors, Kurtz said.
Just how large a deposit depends on the patient's insurance situation, Kurtz said.
Patients with commercial health insurance must make a $500 deposit on their out-of-pocket costs. Medicare patients (without supplemental coverage) must pay $250 in advance, and uninsured/self-paying patients must come up with half of the clinic's total charges in advance, including the surgeon's fee, X-ray and lab costs, Kurtz said.
Separately owned Carle Foundation Hospital hasn't adopted the same pay-in-advance policy, and continues to bill patients separately for the hospital's surgical team, use of the operating room and supplies, hospital spokeswoman Gretchen Robbins said.
"We certainly understand how this matter can be very confusing to the patient, since the hospital is the setting for most surgical procedures and pre-operative scheduling is done by hospital staff in the hospital," she added.
Pre-collection policies like Carle Clinic's are growing more common with the slumping economy, according to the Medical Group Management Association, which represents about 13,500 physician practice groups across the country,
"It's been a practice that's been around for a number of years with better-performing practices," said Ken Hertz with the MGMA Health Care Consulting Group.
But, he added, "with the economic downturn and the increased difficulty in collecting outstanding balances from patients, more practices are adopting this policy. And it's prudent business."
Good business or not, Champaign County Health Care Consumers Executive Director Claudia Lennhoff predicts a prepayment requirement will be devastating for many – especially during an ailing economy and in a community that already has so many cost barriers to care, she said.
"Rather than figuring out ways for people who need care to get care, this just throws another barrier up," she added.
Lennhoff said the uninsured will be particularly vulnerable, because they don't have the advantage of insurance group plan discounts and wind up paying the highest rates for medical care.
Being forced to pay half in advance could force many to put off surgeries that could keep them able to meet their job and parenting responsibilities until their conditions reach the emergency level, she said.
"I think this is a really irresponsible, reprehensible and harmful practice for Carle Clinic to adopt at this time," Lennhoff said.
Carle Clinic spokeswoman Jennifer Hendricks said the clinic asks for the deposit 10 days before the surgery, but the clinic staff isn't going to be unreasonable if a patient needs more time and the doctor thinks the surgery is needed right away.
"This is something that is going to be taken up on a case-by-case basis," she said.
Kurtz said the clinic is notifying patients about the new pre-collection policy at the time they schedule a consultation with a surgeon.
"It's a much easier discussion to have on the front end sometimes, than on the back end sometimes when you get your clinic statement and are shocked at what your financial responsibilities are going to be," she said.
What's more, she said, it gives patients and account representatives a chance to work out a payment plan for the balance that could avert collection actions later and identify resources, such as Medicaid, that may be able to help needy patients cover the cost.
Provena Medical Group and Provena's two hospitals in Danville and Urbana haven't adopted a prepayment requirement, but they do encourage prepayments when possible, Provena spokeswoman Gretchen Wesner said.
Alan Gleghorn, CEO of Christie Clinic, says Christie doctors have done some pre-collecting in certain instances, for example, when the patient is uninsured and the bill is going to be large.
Kurtz said patients have already become accustomed to paying in advance for such things as dental procedures.
Establishing that some payment in advance is also required for surgeries will be partly a matter of "recalibrating the patient, if you will," Hertz said.
"We were so used to just walking into a doctor's office and walking out, saying my insurance will take care of it," he added.
Who on Earth is this Carla Kurtz person at Carle in Urbana Illinois? How dopey is the statement that patients are glad that she reminded them to bring a credit card or check. Good grief.

And Ken Hertz has no business being anywhere near the health care system. The only other person who uses "calibrated" is Obama.

I have an idea --- why don't the physicians and surgeons at Carle Clinic focus on appropriate patient care?

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