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Archive for September, 2009

Medical Business Associates, Inc. advances to Innovate Illinois semi-finals

Tuesday, September 8th, 2009

Medical Business Associates, Inc. has been chosen as one of the 30 semi-finalists (over 130 companies applied) for Innovate Illinois – a statewide entrepreneurial and innovation competition recognizing high-growth entrepreneurs.

The next round of the competition, taking place September 24th at the University of Illinois Urbana-Champaign, includes a 5-minute pitch followed by a short question and answer session.

Grand prize is $30,000 in grant money. Good luck Rebecca Busch and Medical Business Associates!

Read more about Innovate Illinois.

Support my small business in the Shine a Light Competition

Tuesday, September 1st, 2009

Medical Business Associates, Inc. provides a much-needed voice for those that find themselves “stuck in,” “lost in” and “hurt by” our healthcare system. In 1991, President & CEO Rebecca Busch formed Medical Business Associates, Inc. with the vision of delivering data-driven audits for patients, employers, healthcare providers, payers and government agencies. Rebecca is a nurse, patient advocate and health care consultant. She is also a patient, mother of three and informed health care consumer. Her work has provided her with a deep and unique understanding of our medical system. It has also provided her exceptional insight into the problems that patients can encounter.

Rebecca and her team take their role as Patient Advocates very seriously. They empower patients to feel more “in control” of their healthcare experience, to feel hopeful about their health and ultimately become conscientious consumers of healthcare. Rebecca and her team help patients manage, control and reduce their healthcare costs, make informed decisions about their healthcare, guard protected health information, control their healthcare information and prevent clinically adverse outcomes. For those patients that do not have the resources to have a Patient Advocate, they can qualify for help via the not-for-profit organization American Health Care Advocacy of which Rebecca is a Director.

Several years ago, Rebecca had the privilege of helping Janet (pseudonym) – a woman who wanted to take charge of her healthcare experience. Janet came to Rebecca because she was worried about the care that she was receiving. When Janet underwent a common surgical procedure, she experienced intra operative awakening, a rare and horrifying condition in which a person under anesthesia can feel, hear and experience a surgery as it is taking place but is unable communicate with the surgeon in anyway. When Janet came to Rebecca to tell her that the surgeon told her that she “must have been dreaming,” Rebecca began to ask questions to find out how and why this could have happened to Janet and whether this supposed dream was in fact a reality. Janet explained to Rebecca that her mother had a similar experience during open-heart bypass surgery and that her daughter recently did not respond to anesthetics at a dentist visit. Rebecca wrote a supplemental report to put into Janet’s medical record and personal health record detailing what she had experienced. Rebecca told Janet to never let any anesthesiologist “touch” her without reading the anesthesia records from this surgery. Several months later, Janet needed surgery again. She gave Rebecca’s report to the anesthesiologist, who was very appreciative for having this information before the surgery. Janet never experienced intra operative awakening again. This is just one of the many people that Rebecca has helped navigate through our complex healthcare system.

Medical Business Associates, Inc. also fights against healthcare fraud, medical identity theft and the “ethically challenged” that steal from our healthcare system everyday. Rebecca and her team have uncovered healthcare schemes that have saved people millions of dollars.

Vote for us here!

The evolution of health insurance

Tuesday, September 1st, 2009

In 1927, on the eve of the Great Depression, Baylor Hospital in Dallas entered into an agreement with the local teachers’ union. The agreement involved an employee deduction per paycheck paid in advance to the hospital. In turn, the hospital offered hospital-based care for these teachers and their families. This deduction was determined using a community-based rating model. Eventually, an organization known as Blue Cross emerged and started to provide the same type of program. Note, however, that a model known as prepaid practice groups (PGPs) already existed. Prior to this time period, private insurance did not exist for healthcare services. Health insurance offerings were avoided because appropriate premium rates were too difficult to predict, unlike rates for insurance upon the death of an individual. Private insurance plans started to appear in the late 1930s. These plans, however, were driven by risk-based models. They focused on the experience of the group. Blue Cross now had competition and was losing its customer base because of the new private-payer offerings. Blue Cross shifted toward a modified adjusted community rate plan, eventually abandoning it completely and joining the private-payer risk model plans. Eventually Blue Shield emerged to serve coverage for professional services.

This introduction illustrates one of the very first critical “cost shifting” market movements. What does cost shifting mean? It is when the cost of certain activities is shifted to another party. The question is, to whom? Private payers profited by removing high-risk individuals from their plans – they were growing at a rapid rate because during WWII a wage hold was put into place. Employers started to realize that benefit plans could be seen as a non-wage form of compensation. The tax code encouraged employers to view benefit plans as a cost of doing business, and employees never had to claim their benefits as income.

The benefit plan offering generated a significant amount of cash in the healthcare system. During the 1940s and going forward, teaching hospitals were also recipients of large amounts of cash infusion by the government’s investment in research and technology. The flow of cash from both areas generated a significant offering of healthcare diagnostics and treatment options. By 1946, the healthcare market had increased cash flow for hospital coverage. This resulted in increased utilization of hospital services. The amounts of insurance payments and premium programs went up. Hospitals expanded because of the available cash. The market had a significant buildup of resources. The amount of technology was growing at an accelerated rate. This fueled additional use and sale of insurance. The gap between the haves and have-nots exploded. From 1930 to 1965, there was the first big cost shift of high-risk individuals to uninsured status. Who were these people? They were the elderly, the unemployed, the self-employed, the retired and the disabled. With the aggressive advancements in healthcare, the disproportionate offerings between the haves and the have-nots became obvious.

The political arena debated the concept of compulsory insurance or a nationalized health plan. Instead, in 1965 Medicare was born to serve the have-nots. Medicare takes a social insurance approach, and its members are referred to as beneficiaries. Medicaid was also established; it is managed at the state level. Medicaid, however, uses a welfare approach, and its members are referred to as recipients. The market at the time believed that employer-linked insurance would eventually serve as a form of nationalized health insurance. Medicare Part A was created to pay hospital services, and Medicare Part B was created to serve the professional component. To devise a nationalized healthcare program was not necessary. The market, it was thought, would take care of itself.

Excerpt from Healthcare Fraud Auditing & Detection Guide by Rebecca Busch