Column 91 - CE days are changing for insurance agents

Column 91 2015- 4-5


CE days are changing for insurance agents


North Valley Association of Health Underwriters presented its annual CE (Continuing Education) seminar last week.  I was struck by how these type of events have changed.

The meeting included a panel discussion with executives from both Dignity Health and Shasta Regional Medical Center and Dr. Jonathan Osborne of Prestige Medical Group.  I continue to be impressed with Dr. Osborne's eagerness to be involved in community events that support educating the public about health care.

Dr. Osborne stated that providers spend $.40 for every $1.00 collected from 3rd party payers like insurance companies and Medicare.  (That number seemed rather high to me.)  His practice is quite different, based on a membership model with a fixed fee for unlimited primary care.

 "This is not concierge medicine", he was quick to point out.  "Our model provides a balanced & focused approach to primary care,  that allows us to spend more time with the patient, keeping folks out of the Emergency Room and limiting specialist referrals". 

He explained that many primary care doctors have limited time with a patient and will often feel they need to refer to a specialist because they are unable to spend the time needed to solve the problem.  

He added that most primary care practices include about 2500 patients per physician, while it should be more like 900. His model is limiting patient load to 600.

I was particularly pleased to hear that his practice is serving several Medi-Cal families.  There was a concern that regulations would prohibit this, but since he is not billing them directly for services, but rather they are paying a membership fee, it works. 

Access to care for Medi-Cal patients has been a huge issue in our community.  I think this is a terrific solution for those that can afford the fees.

All members of the panel agreed that complying with the new ICD10 coding rules is burdensome for everyone.  They did not seem convinced that collecting more detailed information was going to benefit the public.  Joan Heffley, Business office Manager from SRMC gave one of the most outlandish examples of coding which assigned a code to an astronaut who stubbed a toe.  I can't help but wonder if someone wasn't just having fun when they put that code in the mix- perhaps just checking to see if anyone really looked?

It is my understanding that this change to the coding system (which hasn't been changed in decades) is designed to help with the ultimate goals of lowering health care costs, by tracking the efficacy of the treatment we receive.  Without good data, it's much more difficult to do.

But of course, when a new system is implemented there is more potential for error in coding, which will result in claims being denied and necessarily appealed, adding to the administrative burden for all participants.

All panel members agreed that Tele-Medicine will be a growing component of health care.  From bringing high level specialists to a case, or simply expanding Prestige's services to Hayfork, they believe it will be needed. In addition, they agreed that the use of mid-level practitioners like FNP (Family Nurse Practitioner) can enhance services to an underserved population.

Some career advice was also given.  Dr. Osborne as well as Patrick Varga, COO (Chief Operating Officer) of Dignity Health Redding agreed that the path from LVN to RN to FNP can bring a breadth of experience to the individual.  Further, this allows an opportunity to grow one's professional skills over time and not come out of school with the average $350,000 medical debt of today's physician.


It was agreed that medical tourism is not a big competition issue for our local providers, since most of our population simply couldn't afford it.  But Dr. Osborne is a big fan of services in Singapore and Thailand, having experienced the birth of his child in Singapore.  He was living in China, but does not have much confidence in their system and elected to go to Singapore.  We are seeing more large group health plans provide coverage for this type of service.  From purely a cost perspective, it certainly makes sense.

This brings me back full circle to thinking about the origins of medical insurance.  Originally, we all simply paid for our medical services.  Access was mostly limited by ability to pay.  Then Blue Cross established pre-paid hospital plans where you pre-paid for hospital stays and limits were clearly spelled out in the policy under an RVS code that assigned a flat dollar amount per unit to services.  Pre-paid physician services came about under the Blue Shield label.

Of course, there's more involved, but it is interesting to watch how things seem to come full circle.