Unexpected bills to patients for out-of-network medical care have been a problem for years. Patients, their providers – both in and out-of-network – and the insurance carriers (the “payors”)  have likely been involved at one time or another in the sometimes messy situation triggered by an out-of-network provider submitting a claim for charges. Payors have been trying to eliminate the

Continue Reading Out-of-Network Billing – New Hope for Patients

In order for an accountable care organization to succeed, there must be a workable method for collaboration among the providers.  How do providers of care effectively communicate amongst one other?  What is the optimum means of memorializing a patient’s medical history and present health status so that all providers of care are basing their decisions on the same data?  And
Continue Reading Accountable Care and Collaboration Among Providers

Now that the Affordable Care Act has been upheld by the U.S. Supreme Court, the requirement to control costs is critical.  One thing we can learn from the experience of near universal coverage in Massachusetts is that providing access to more citizens without containing costs is a recipe for disaster.  In 2006 Massachusetts achieved coverage for roughly 98% of its

Continue Reading Affordable Care Act: Bundling Payments to Control Costs