The Provider Insurance Revenue Study in Healthcare Providers in the United States of America
NCT ID: NCT04587245
Last Updated: 2021-10-18
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
100 participants
OBSERVATIONAL
2020-10-01
2022-10-15
Brief Summary
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Detailed Description
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As Physicians were able to return to work in the early Summer, even if only partially, many had to adjust to the newer medical practice of telehealth, and the lower revenues that came with it. The Centers for Medicare \& Medicaid Services (CMS) gave assurances to Physicians that Medicare would reimburse telehealth encounters at 100% of the office visit rate. But private Payers were under no such obligation. Across the country, Physicians are reporting that they're being reimbursed at about 70% of an office visit rate despite the fact that telehealth requires both resources and expertise to implement effectively, and each encounter takes up to twice as long as an office visit.
Adding to financial hardships, Physicians across the nation are reporting that legitimate insurance claims are being held up and denied by the insurance companies at a higher rate than ever, cutting off the cash that they need so desperately. As of June 1, only half of Physician practices say they have enough cash to stay open for another month.
In just 2 months in the spring of 2020, over 45 million Americans lost their jobs and for many, that also meant the loss of their employment-related health insurance. Despite shedding a massive number of members from their rolls, health insurance companies are actually predicting record profits for 2020. The pandemic it seems, is very good indeed for the health insurance business. Private investors and executives are taking huge dividends and bonuses out of the system just at a time when US healthcare needs a vast new investment of healthcare resources into the system. The good fortune of a few individuals and corporations comes at an as yet untold expense to American society.
The formula for insurance company success in a pandemic only happens one way. By keeping member premiums, delaying payments, and denying treatment authorizations, the large health insurance companies are taking advantage of the profound misfortunes of both doctors and patients during a national health emergency.
The COVID-19 pandemic will have adverse effects on the health of Americans that will be sprawling and long-felt. However, it is not for this study to decide whether private interests will always be antithetical to public interests when it comes to healthcare. That is a public debate that will continue to evolve as the profound weaknesses of the American way of distributing healthcare are magnified and exposed in a time of social upheaval.
The investigators do know that in order to get a handle on the major damage we see occurring in real-time- and to inform that debate, it is first necessary to measure it.
Conditions
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Study Design
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COHORT
RETROSPECTIVE
Study Groups
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Physicians
Physician or healthcare Provider based anywhere in the United States who is eligible to submit claims to an insurance company on behalf of patients
Online questionnaire and interviews
Online questionnaire, financial statements (one month per quarter in 2020) submitted electronically, interview with professional accounting firm and review of data and exit Interview
Interventions
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Online questionnaire and interviews
Online questionnaire, financial statements (one month per quarter in 2020) submitted electronically, interview with professional accounting firm and review of data and exit Interview
Eligibility Criteria
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Inclusion Criteria
* To agree to participate in this study
Exclusion Criteria
ALL
No
Sponsors
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University of California, Irvine
OTHER
ND Sciences, LLC
INDUSTRY
Responsible Party
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Principal Investigators
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Henry Broeska, PhD
Role: PRINCIPAL_INVESTIGATOR
University of California Irvine Beall Applied Innovation
Locations
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University of California Irvine Beall Applied Innovation
Irvine, California, United States
Countries
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Central Contacts
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Facility Contacts
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Other Identifiers
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PIRStudy
Identifier Type: -
Identifier Source: org_study_id