by Sally Ginsburg, MD, for athenahealth
I recently read a New York Times article about the salaries of insurance executives that left me gobsmacked. Did you know the average annual base salary of insurance company CEOs in 2013, according to the article, was $544,000? (Wait, that’s just the base pay — annual total compensation is typically between 11 and 18 million dollars.) If the health care reimbursement process was a seamless one, then perhaps these numbers wouldn’t leave such a horrible taste in my mouth. But that’s not the case.
I doubt that I am alone in thinking U.S. health insurers have somehow negotiated themselves the deal of the century. They have managed to create a situation in which they collect huge sums of money in the form of premiums, not having to make payments until all the patient responsibility — co-pays, coinsurance and deductibles — max out. Once that maximum out-of-pocket limit is reached, then the payers are obligated to pony up their reimbursement payments.
The payment paradigm in health care is in the midst of a gradual, yet massive shift, from the classic fee-for-service model to a system that rewards value; at the same time, it has become increasingly difficult for patients or physician offices to contact insurance companies.