President Obama, the Insurance Industry & Chiropractic
by Dr. Mark Studin DC, FASBE, DAAPM, DAAMLP
On May 11, 2009, in New York Newsday, The Associated Press reported a coalition between insurance companies, drug makers, hospitals and doctors to contain and control health care costs to lower the premiums, so that the 50 million Americans who are currently uninsured can get insurance. This is reported to be as a result of President Obama’s health care reform push.
Health care industry leaders have pledged a two trillion dollar voluntary reduction in spending over the next ten years in order to pay for the program and will report to the government in concert with President Obama’s health care reform plan. Although this doesn’t resolve the health care problem, it gives enough room to insure many of those uninsured, and will allow those special interest groups to maintain their influence over Congress in writing the legislative bill.
It has been reported insurance companies complained that, if the government took over insuring many of the uninsured woman and children, they would go out of business. The carriers would not comment on why. The reasons are quite transparent; when you control the marketplace, you control the profit. If the government steps in, then the insurance industry loses control and loses profit margins.
Some facts: "Big health insurance company profits mean big pay for health insurance company executives—some $14.2 million a year for the top seven CEO’s," reported Mike Hall of the AFL-CIO on March 10, 2009. He goes on to report that, "Ethan Rome, deputy campaign manager for Health Care for America Now, found that, ‘…during the past five years, health insurance company profits have soared by 1,000 percent while health care premiums for working families have risen five times faster than wages. They raise our premiums, they raise our deductibles, they raise our co-pays each and every year, and now they’re conducting a fake campaign for reform.’"
In spite of the catastrophes, they posted a conglomerate profit of $44.8 billion according to The Los Angeles Times.
If you would like the full text of his article and the links to the organization, go to their blog, http://blog.aflcio.org/2009/03/10/health-insurance-industry-gets-the-profits-patients-get-the-shaft/
If I were writing an exposé on insurance companies, it would be easy to find hundreds of resources within two minutes of researching the internet; but this is about you, and not them.
If you think that the insurance companies are doing this out of social conscience, then I want you to get ready for Santa Claus and the Easter Bunny. You stand a better chance of those coming!
This is about profit, power, greed and damage control. The insurance companies are in business and their business is not safeguarding Americans against cancer, heart disease and subluxation. They want to get away with paying for as few services as they can and KEEP the rest.
Henceforth, the insurance industry has experienced windfall profits at our expense. An example arose in 2006, after Hurricane Katrina and numerous other hurricanes cost the carriers billions. In spite of the catastrophes, they posted a conglomerate profit of $44.8 billion according to The Los Angeles Times, with their top executives reporting an 18.7% profit in the worst of times. During that tough economic year for the insurance industry, their surplus was $427 billion.
The question now begs itself, "Where are the insurers going to get the difference, if they agree to lower premiums?"
Part of the answer is so clear; I have been shouting it at you for over a year, "They are going to get it from you!"
Reported in the May 6, 2009, issue of Dynamic Chiropractic, Blue Cross/Blue Shield just took the physician status away from chiropractors. Why? Not because they are prejudicial; it is because they pay certain claims exclusively to physicians and now do not have to pay you. This is a huge blow to the chiropractic profession, as President Obama proposed healthcare reform plans would likely have included chiropractic in full scope coverage. Not anymore. This is only the beginning.
Retrospective reviews are a billion dollar a year industry and now the big picture is unfolding to the general population for those smart enough to see it. If you are not, I am about to rub your nose in it…to protect you, your practice and your family. The American Chiropractor magazine asked in a recent poll, "How many of you have had or know at least two people who have been subjected to a retrospective review?" Twenty-five percent answered in the positive.
In addition, Medicare just tripled the number of auditors to perform more retrospective reviews; and just three months ago, a chiropractic managed care company reported they, too, were jumping on the bandwagon to perform retrospective reviews to get money back from you!
Because many of you have such inconsistent documentation and poor notes, you are an easy target. First, if you still use travel cards, I want you to take out red, yellow and blue paint and paint a bull’s eye on your forehead. This way when (not if) they come, you will make it easier for all involved…and you will deserve it, because you have been forewarned over and over. Six months ago, a representative from a lawyers’ coalition that represents insurance companies stated that chiropractors who still use travel cards were the easiest targets for retrospective audits, and the first ones to get audited.
For those of you who have full charts, good for you. That is the first major step towards bulletproofing your practice with regard to retrospective reviews. The next step is what’s in those charts. Everything needs to be clinically correlated as to International Classification of Diseases (ICD), Current Procedural Terminology (CPT) evaluation, orders, treatment plans, re-evaluations, your care, etc.
The last and most critical step is to get a VOLUNTARY AUDIT. If you haven’t listened to the forty-minute interview with Mr. Peter Birzon, a prominent health care defense lawyer who has defended over 5,000 doctors, please go to www.TeachChiros.com and click on "Audio Library." This is a FREE service and "a must listen." It will open your eyes to what needs to be done—not now, but months ago and certainly not months from now.
Secondly, if you haven’t had a voluntary audit, I urge you to call Dr. Michael Schonfeld at 1-516-695-7732. He is a chiropractic audit specialist who will ensure your records are in order. The time, once again, is right now. His $500 fee is the best money you could ever spend, considering a health care lawyer gets $400 per hour once you get papers for a retrospective audit, and they usually take two to three hours simply to listen to you. Again, don’t be penny wise and dollar foolish; there is a reason why hospitals and large group practices employ in-house compliance officers at six-figures and better per year.
I have spoken with dozens who have used Dr. Schonfeld’s service, and there has not been one complaint. To learn more, again, go to www.TeachChiros.com and click on "Compliance Auditing."
The reason I feel passionate on this issue is that I get too many phone calls weekly on new retrospective audits from doctors nationally. Everytime, the doctor is angry, scared and always says, "I should have gotten that audit. Now I am going to have to pay dearly."
Reading the newspaper underscores my resolve to protect those smart enough to listen, because the insurance industry is perhaps the shrewdest sect of business worldwide and they are hungry, greedy, ruthless and only care about their bottom line. They are not willing to give up their unprecedented profits; they are just looking for new sources, and you are one of those.
Dr. Mark Studin is the President of CMCS Management which offers the Lawyers Marketing Program, Family/MD Marketing Program and Compliance Auditing services. He can be contacted at www.TeachChiros.com or call 1-631-786-4253