Senators say they’re serious about tackling surprise medical bills

If you have an emergency, you often don’t have a choice about which provider treats you.  HMOs offer in-network coverage only.  High deductible health plans (HDHPs) may or may not have out-of-network options. Hospitals need to set the tone.  When an emergency department hires non-contracted providers, they must accept the insurance carriers with which the hospital is contracted.  If the... Read More

“Medicare-for-all”: The Culprit, Not the Cure

WOW, Medicare-for-all will cost only another $32 trillion!  A drop in the bucket.  We deserve to pay nothing, right? Free healthcare—put it in my basket—I'll take 3 of them! When will proponents of "Medicare-for-all" understand the cost of healthcare is based not on greed, fraud, waste, and abuse (although they do contribute), but rather on our utilization?!  In other words,... Read More

Transparent Hospital Pricing Exposes Wild Fluctuation, Even Within Miles—DMV Area Edition

According to data from Payer Compass, which shows 2013-2015 data for overall ratios of charges to actual Medicare payment for all Medicare-certified hospitals, going to different hospitals close by in the region can result in very different bills., Because of Maryland’s partnership with the Centers for Medicare & Medicaid Services (CMS) between 2014-2016, “all-payer per capital total hospital revenue growth... Read More

Service and Education: The Keystone of Our Mission

Potomac Companies incorporates strategy, software, and service as the core of our broker-consultant relationship.  We use powerful analytics software, along with our CEO’s analytics expertise, to model renewals, new coverage, and funding approaches.  Our signature KISS – Keep It Simple Solution™ program takes technological and administrative approaches to minimizing errors and maximizing efficiencies in HR.  Service is the keystone of... Read More

Healthcare Industry Hand Hygiene Compliance: Zero Tolerance

The American Journal of Infection Control recently published a study on hand hygiene compliance (HHC) among healthcare workers. Here are some key findings from the report: Hand hygiene compliance was 91% for health workers observed overtly. For workers who were observed covertly, hand hygiene compliance was 49.3%. HHC based on covert observation increased to 66.9% after an intervention.   To... Read More

Urgent Care Center Impact on Emergency Department Use

In a working paper issued in January 2019 by the National Bureau of Economic Research (NBER), researchers examined how urgent care centers (UCCs) impact emergency department (ED) demand.  After urgent care centers closed for the day, ED visits for minor illnesses by privately insured patients in locations with multiple UCCs increased by 1.4% (2.4 million ED visits) because UCCs are... Read More

Our Collective Pocket

The California Health Care Foundation released a report earlier this year on US healthcare spending. Here is the breakdown for the 3.3 trillion healthcare dollars spent in 2016:    28% of total health spending in 2016 was paid for by the federal government. Households accounted for 28% of total healthcare spending in 2016. Private businesses paid for 20% of total... Read More

Prior Authorization Debacle

The Death of Yarushka Rivera: Prior Authorization Run Amok   Bureaucracy claimed a 19-year-old victim in October 2009 and her case is still being litigated today.  The suddenly required prior authorization for Yarushka Rivera’s necessary-to-live Topomax defied common sense.  Caught between an unaffordable $400 out-of-pocket cost, unresponsive prescribing physician’s office, and lip service from the pharmacy, Rivera suffered a fatal... Read More

Unhealthy America

The Urban Institute released a healthcare proposal on May 14th, to expand upon the Medicare Program and ACA Marketplaces.  The Healthy America program “combine improved financial assistance, an improved public program with a broad provider network, provider payment rate caps to boost insurer participation and counteract the monopoly power of health systems in some areas, autoenrollment for very low-income... Read More