Category: Business

Insurance And Medical Billing

 

There’s been a lot of talk about health care reform – years ago when the ACA was written, over the summer when the Republicans were working on a replacement bill, and again now that health care is trying to get slid in with tax changes. At no point has any politician addressed the real problems in health care costs: medical billing.

Scott went to his doctor for a routine checkup — a preventative service that is 100% covered by insurance. The doctor asked him if there’s anything else. He mentioned back pain, and his primary care physician referred him to a back pain specialist. We get the bill and he got billed for both the routine checkup and a medical appointment. Evidently, when the doctor asks if there’s anything else during a routine checkup … the answer is NO WAY IN HELL, otherwise you get billed a couple hundred bucks. Didn’t look at his back, didn’t prescribe any medication. Just said “yeah, you’ll need to see a specialist”.

The worst part is, in talking to the medical billing people, a doctor doesn’t know at what point a conversation will be deemed sufficiently in depth as to incur an additional code on the bill. There is absolutely no other situation where people would accept blindly accepting a service without knowing the charges involved. Could you imagine taking a University course and getting a bill at the end based on some financial department worker’s interpretation of how much interaction you had with faculty and educational resources for the duration of the class? A restaurant meal where the bill comes six months later and is based on the time you spent at the table, each interaction with a server, you chatted for a few minutes with the guy who brought the beer and that’s an extra fee because you discussed the IBU of their different offerings. Could have just said hoppy bitter flavor, but you used a technical term and incurred a consulting fee. Hell, you take your car in for service and they’ll provide an estimate before performing maintenance.

What I don’t understand is why we accept this billing model for medical services. I saw someone on SharkTank a week or two ago selling at-home medical testing kits. Her sales pitch wasn’t just the convenience (or privacy) of testing for medical problems at home. It was that there was a known cost for each test. You want to know your cholesterol levels? That’s 80$. Thyroid problem? Measuring TSH, TPO, free T3, and free T4 levels costs 150$. You pay in advance, you know how much it costs, and you don’t get a bill thirteen months later for services you never consented to receive.

What recourse do you have when the Cleveland Clinic screws up your appointment and you end up with expensive bills you didn’t anticipate receiving? Or a quick comment to a doctor garners another 150$ charge? Not a lot. Leave messages for their ombudsman who never returns calls. Pay the bill and appeal to the credit card company? Take them to small claims court?

Corporate Expense Reduction: Customer Service

We analyse calls to both our internal and customer-facing support desks all the time in an attempt to identify what causes the most calls. Theory being that fixing whatever-it-is would significantly reduce call volume and thus expenses. But do we ever analyze who is calling us? It may be a single problem that reoccurs. It may be ten little problems indicative of a bigger issue. It may be someone who is trying to avoid work and booking offline time on the line with the help desk (it’s been 20 years, but I used to generate a report for each call center manager of their director reports’ tickets & resolutions each week because it was so common a technique for a freebie 20 minutes off the phones and the manager didn’t have visibility into the ticketing system to determine if the calls were legitimate or not).

Multi-million dollar accounts (or senior company execs) get dedicated liaisons who walk issues through support channels. What if we had a small team of transient white glove support liaisons? People who have cultivated the same process knowledge and contacts that major accounts managers and exec support managers have. The top five callers for the week/month get rung up and their issue fixed. That may be calling around to get the proper support organisation looking at the issue. It may be replacing the thing that keeps breaking (replace the employee’s PC, replace the customer’s DLS modem). Even if you break even, there’s a much better experience with “yeah, I called in five times. But then so-and-so rang me up, took ownership of the issue, and fixed it” than “I have called eight times a week for the past month, had to explain the problem two dozen times, and these dolts finally managed to fix it”.

The other thing the metric could give you – and maybe a company would never use this – is how much a customer is *costing* the business. 800 charges, support staff man-hours … someone who has a 5$ a month account but uses ten hours of customer service time is costing the company money.

Corporate Expense Reduction: Energy

One of the things we’ve done with our home automation is tracking energy usage – partially because we want to size out a solar installation and the net metering in Ohio is awesome unless you produce more electricity in a rolling 12 month period than you use. So the installation has to be really close to your actual usage. But also because electricity costs money. Similar approaches may be beneficial to corporations. I’m using our 11 cent per kWh rate as an example. Actual rates depend on location and usage.

Does a company want to devote resources to “office automation” like we have home automation? Coupling motion detectors with smart outlets {or even just office schedules – if the last person is off shift at 7PM, dropping some device power at 8 should have no impact} to turn off power might save a lot in standby draw.

Even without home automation, companies can gather usage data to allow resources to be devoted to their biggest energy draws. The first step is identifying the big draws. We use Aeon Labs zwave clamp on home energy meters, but there are stand-alone energy meters. I’ve seen DIY Arduino based ones (https://olimex.wordpress.com/2015/09/29/energy-monitoring-with-arduino-and-current-clamp-sensor), or high end Fluke devices with clamps do the same thing (@5k+ for the Fluke … that’s a bit of an investment, but if someone’s got an energy metering capable fluke for other work ‘stuff’ … they may just need the 10$ clamps). Whatever equipment – clamp it on one circuit in a panel for a few days. Get a number, move it to the next circuit. Eventually you’ve got daily usage numbers for different circuits and just need to look at what is on those circuits to narrow down potential saving points.

We found obvious stuff – HVAC uses a lot of power. If a company leases a building with outdated equipment, use firm numbers in lease negotiation. The HVAC draws x kWh per year which costs us y $. A middle-road new system should draw z kWh which means we’re spending some concrete dollar figure per year because this system is so old. The same information can be used to cost-justify upgrades/replacements for company-owned buildings. Measure usage on lighting circuits. An office with old ballasts and florescent bulbs – what they are costing to run tells you if switching to LED {and there *are* LED T4/8 tubes that don’t require fixture replacements} makes any sense.

But we also found things I would never have even considered if I made a list of all of our non-trivial electrical draws. 20% of our annual electrical usage is the septic aerator (it literally uses more energy than the geothermal HVAC system in a year). We can get it down to 11% of our projected usage by cycling the thing on during even hours and off during odd (or on/off in twelve hour chunks, or 4 on / 4 off / 4 on / 4 off / 4 on / 4 off … new aerators have scheduling and do this themselves). Now that septic aerator savings is only like 250$ a year. Not a huge amount of money, but it’s 250$ I would never have realized we were spending otherwise.

From an IT perspective – if a server supports wake-on-lan … does a backup server and tape library need to be running 24×7? If someone kicks off a restore, can it be powered up (adds a minute, but saves power whenever restores aren’t running) and can it be programmatically powered on maybe half an hour before its backup jobs are scheduled to kick. Then power back down when no jobs report as running or scheduled for x hours. As a company, we mandate that all computers be left powered on so patches can be deployed overnight. What if the nightly patch check-in then powered the computer down (either because there are no patches or after installation in lieu of a reboot)?

Or a printer — there is no need for the printer to be in standby mode for the 15 hours a day no one is around to print. Or the weekends when no one is around. Or company holidays. One of the fairly large Xerox printers we have draws a continuous 11 Watts in sleep mode uses 71 kWh each year between 17:30 and 07:30 M-F and all day Saturday and Sunday. Maybe 72 kWh if you add company holidays. That’s not quite eight dollars a year in savings (and power consumption won’t be 0 if the device can be woken remotely) – but saving 6$ per printer in a company with 2000 printers is 12,000$ each year. Some of the older printers don’t even have a lower power sleep mode and draw 95 Watts in standby mode – 620 Watts per year when no one is around, and just under 70$ in electricity. Even better – HP offers an auto-off / auto-on on activity feature that allows energy to be saved during working hours.

Are there intangible benefits to energy saving initiatives? Get into the automation side of energy savings, would some tech magazine profiling the effort (free publicity, and tech magazines are a good place to advertise a company offering network services)? Can companies form partnerships with geothermal / solar / wind / whatever manufacturers to get cheap installations + publicity? Sadly, in some markets that may not play well (what, you don’t want to burn coal!?!) … but it might not be seen as a negative if it approached as a “save money, do right by stockholders AND customers” message instead of a “green, save the planet, global warming is bad” message.

Corporate Expense Reduction Strategy: Procurement

We have a 3D printer, and have an evolving list of things to 3D print. Custom design work comprises most of the list now. Originally, I anticipated printing a whole bunch of little plastic bits that are seriously overpriced in retail stores. The bobbins for embroidery thread come to mind — 20 cents a piece (although I’ve subsequently found them at Walmart for 10 cents a piece). They weigh practically nothing. 3D printer filament runs between one and a half cent per gram and four cents per gram (not getting into pricey exotic stuff which doesn’t make sense to use as a base for winding embroidery threads!). I can print six for Walmart’s super cheap price!

And then I thought to check AliExpress – two cents a piece. I can buy 100 for less than the price of 28 at Walmart. Material cost would be a little lower printing with the cheapest filament. But there’s electricity and time to consider as well. I ended up ordering the things shipped from China.

But in the process started wondering if companies use either of these techniques for reducing expenses. 3D printing would be an interesting endeavor – include the company logo, make items the *exact* size needed for an application. But direct ordering from overseas manufacturers has a larger opportunity for expense reduction. Pens for a cent or two each. Ten thousand staples for five bucks. Paper clips, wires and cords, clip boards … there are all manner of random little consumable things companies buy. Start running low on staples, order another ten thousand. So what it takes six weeks to arrive? You’re just refilling a supply closet.