Dr. Isaac Yang on Reimbursement

Dr. Yang, a neurosurgeon specializing in the surgical treatment and clinical outcomes of adult brain and spinal cord tumors at UCLA, shared his insights into reimbursement with us at the 2019 GS Symposium. Here are three key questions and answers from the interview.

 

Q 1. How does Medicare affect your hospital financially? Would low reimbursement on Medicare affect patients’ treatment options?

IY: Low reimbursement rates from Medicare are forcing care providers to consolidate. It will eventually lead to higher medical treatment costs, because now integrated hospitals have numbers to negotiate higher prices. It also facilitates to create a two-tiered system, which can be bad for actual health care outcomes.

 

Q 2. What is the current situation of case denials and can you share some practical tips to prevent them from happening?

IY: Denials for imaging and surgeries are becoming more common. CT scan denials can happen without neuro deficit. Misinterpretations of medical knowledge from insurance providers can cause issues with denials for routine and necessary medical scans. I believe one way to minimize case denials is to have a specialty in your service.

 

Q 3. What do you think of Haven (Amazon healthcare) or other healthcare insurance alternatives?

IY: Vertical integration of the entire healthcare system hasn’t worked before, technology companies have been trying to insource the healthcare market. Amazon is one of the companies trying to do this and Walmart might be involved in it, too. The downside could be that all of the savings from integration will not to go to patients or doctors; it would go back to the companies. A huge company would fly patients to different cities to receive care as long as it makes sense economically.