This is the link from CMS which discusses how long private health plans need to insure someone with ESRD until Medicare becomes the primary insurer - 30 months!!! Medicare is only the secondary insurer during this time frame so there is a huge window of time and therefore a huge economic incentive for an astute Medical Director or Benefits Manager at a large corporation to try to start an intra-company kidney donation program to save the company health plan a tremendous amount of money while saving/improving the lives of employees with ESRD.
In short: In dollar$ and cents...If a health plan is spending ~$100,000 annually per person with ESRD, then in the 30 months before the person is transferred to Medicare the cost comes to ~$250,000. Cost of kidney transplant ~$25,000 plus budget $1,000 per month for the best anti-rejection meds on the market. In the same 30 months, assuming you can do transplant during the first month, costs to the health plan would be $25,000 for transplant + $30,000 for 30 months of anti-rejection meds + throw in even $30,000 (high estimation) for complications ($1,000 per month for 30 months) for check ups with urologist/nephrologist, scans, etc. and you are still at only $85,000.
This comes to approximately a savings to the health plan of $165,000 in the 30 month time frame before the person is transferred to Medicare (and hopefully, they live that long).
Multiply that time 10 or 100 in a large health plan and we are beginning to talk about some real money.
The following is the pertinent text from Centers for Medicare and Medicaid Services Website:
"Medicare is the secondary payer to group health plans (GHPs) for individuals entitled to Medicare based on ESRD for a coordination period of 30 months regardless of the number of employees and whether the coverage is based on current employment status. Medicare is secondary to GHP coverage from COBRA or a retirement plan. Medicare is secondary during the coordination period even if the employer policy or plan contains a provision stating that its benefits are secondary to Medicare."
Good early mrning Monday Eli Dov,
ReplyDeleteIt took me several reads before I understood your math in the first paragraph. The reason was not that I didn't understand the numbers, but I found your sentence construction a bit awkward .
Would it be a good idea if the Feds awarded tax breaks to such companies upon demonstrating real savings of $165, 000/ patient and its successful reinvestment to better internal company technology, reward good employees with salary increases rather than lining already silken executive pockets with
additional perks?
Alan Busch
I think the sentence structure is awkward; i'll try to fix that later...
ReplyDeleteMy focus is on improving life expectancy and quality of life. The economic incentive is there to try to induce someone into trying it.
My thoughts regarding where the $ would go are:
the lower the healthcare expenditures are, the less money that the employers and the employees need to contribute towards their health coverage leaving more money for all parties involved.
This program is self financing so there is no need for any governmental intervention needed to incent the companies to act so there is no need for ant tax breaks.
Again, this program does not speak to specifically where the money will go, but I don't think that one needs to assume the money will go in any substantial way specifically to
"silken executive pockets."
Post fixed - now should be more readable and understandable.
ReplyDeleteSorry about that.