Miscellaneous And Off Topic Subjects

[iam416]

Also, in Ohio, there are 2 really questionable House districts out of 16. And both are in Cleveland. One was a definite R-screwjob. The other is a definite AA district.

There are a couple other weird districts, but nothing that is, IMO, outrageous.

[AlabamAlum]

Jeff said:


my emphasis

Getting there.... When you look at your hospital bill, and you are charged $ 5.00 for a crappy box of tissue, most folks (1) wish they could have had Kleenex and (2) just let it go. Somewhere, there is someone who is profiting from this obvious mismatch of need and supply. When these costs are in the system, it is foolish to rail against "profit" because the real question is "where is the excess going?" What we have with the ACA is a vast and growing government bureaucracy "overseeing" an extensive private bureaucracy. The idea that placing one bureaucracy in charge of another will cut costs is ludicrous to any reasonable person. So the light bulb goes on: "hey, why don't we just eliminate the private bureaucracy..."

Why don't we take the excesses out of the system in the first place? We will never know, but do you remember when policing changed and even the little things like broken windows were a concern? I don't know if that could happen with medical bills, but it certainly wouldn't hurt to try. Hanni makes a good point that folks really only care about their deductible. Why not make the deductible a percentage of the total bill? Why not itemize a pro-rated share of insurance costs and legal fees on each bill? In other words, be transparent about the hidden costs of health care and allow the individual patient have a vested interest in lowering the bill. I don't think we have ever even talked about how the US legal system affects negatively the health care system.

Thinking that "equal" treatment of the poor is attainable or even desirable is just magic thinking. It has never happened anywhere. We need the best possible treatment for the poor where they are located.

The $5 box of tissue is, by-in-large, a unicorn. Medicare and a number of private insurers pay by DRG (diagnostic related group). In other words, you get $7500 for admitting a heart failure patient. Whether they stay 1 day or 100, and no matter how many supplies they use. It's all inclusive. And if they're quickly readmitted (less than a month from discharge in some drgs), you don't get more money.

Medicaid also does DRG, but they also do a per diem ($ per day in the hospital), and a FFS (fee for service). Depending on what and where ... We do good to break even with the CMS (Centers for Medicaid Services) stuff.

Private insurers that allow us to bill itemized for supplies do not pay what we have listed on our charge master if it's excessive. They have their own payment master that reimburses the box of tissue for 79 cents or whatever. They call it "UCR" - usual, customary, and reasonable.

Uninsured that pay off their bill (haha, talk about a unicorn) will see a $5 charge, but this is easily negotiated.

So, why do it? One reason is that different insurers have different pay masters. Some will pay 79 cents for the tissue and some will pay $1.50 or whatever. This let's us capture all of it. Also, many hospitals will write off a portion of what is not paid by the insurer as a loss.

[AlabamAlum]

Also, in Ohio, there are 2 really questionable House districts out of 16. And both are in Cleveland. One was a definite R-screwjob. The other is a definite AA district.

There are a couple other weird districts, but nothing that is, IMO, outrageous.

An AA district? Sounds mega cool.

[entropy]

AA... You're overly simplifying the payment process. =)

[AlabamAlum]

AA... Many are hiring MD's to push business into their hospitals and/or create ACO's. I know several who don't make money on buying physician practices but do in the totality of a persons care. Something you probably know/understand..

Ideally, I think you'd want an alignment of independent physical offices that does the same thing. I do think the reaction to the cost pressure is leading many orgs into a different direction. jmo


I also think there is regionalism based upon competition, state rules and hospital goals on the % of physician practices that are owned independently or not.. so I'm not surprised you'd see that in your area.

I forget the name of the group in Chicago, but a large physician practice started buying other practices and they created a large enough organization that the hospitals have had to negotiate with them on where they are sending their patients. Rather surprised that didn't become a more common model.. Not dominant, but just more common.

It's better to contract with as opposed to actually hire, IMO (I have done both). It seems like a minor distinction, but the latter is fraught with peril (again, IMO).

[Wild Hoss]

An AA district? Sounds mega cool.

An entire district modeled after life in The Birdcage? FTW!

[AlabamAlum]

AA... You're overly simplifying the payment process. =)

A bit, perhaps, but with reason.

[Jeff Buchanan]

E, my main point is that the FFS reimbursement model is NOT what is driving up health care costs as I thought you were saying. If this model has any impact on costs it is marginal. In my view they are not directly related ...... this is what I meant when I said one can conflate terms and draw wrong conclusions.

The larger point is that physician reimbursement in whatever form is not the major factor in the cost of increases in the US health care system. It is profit seeking by the entities I mentioned. I thought you were taking providers to task for doing unnecessary stuff and by doing so running up the bill for an encounter. If it happens, and I'm sure it does, it's impact on overall health care costs is again minimal.

Certainly there are "privately" owned physican practices but one has to be careful in assessing what that means in the context of this discussion. Solo practice is rare. Large group practice is common but we're talking about 15 plus MDs, a staff of 50 or more employees and annual practice income in the millions. These groups are managed by suits, usually not the MD owners. They also command attention from insurance companies because they have a large patient census and, like hospital systems do, they will negotiate profit driven deals for the practice. In this setting, affiliation with large hospital systems is also common. Are greedy MDs involved here? Maybe, but, again, the impact on healfh care cost overall is miniscule

The point is that its the profit motive of large entities driving up costs not FFS, not individual money motivated providers running up the bill on a single encounter and its not because our system isn't doing enough preventative care. It is the influences of profit driven entities in the health care delivery system that have to be mitigated to contain costs at sustainable levels.

[Wild Hoss]

Healthcare nerds...

Sent from my SM-G900P using Tapatalk

[entropy]

AA... you mean you don't want to do into the DRG negotiation process with insurance companies? Or describe how a health system might will have multiple payers with unique DRG's/plans for the same condition? Or how there are around 68,000 ICD-10 codes....

=)

[Hannibal]

Allright smart guy, what were the major differences in economic policies?

Only economic policies? The gang of 17 did not last long enough for each of them to describe their plans in detail. But if you can't see that there was not a massive cross section of ideologies and approaches to government in that group, then you were not paying attention. There was everything from the stereotypical old school "abortion and Jesus" Conservatives like Rick Santorum and Mike Huckabee to the more Libertarian Right like Rand Paul, to Ted Cruz the hardcore strict Constructionist legal scholar, to John McCain 2.0 (i.e. John Kasich) to George W. 2.0 (Jeb), to the obvious guy whose ideas stood out the most -- Trump. Immigration wasn't even an issue until Trump made it one. There were candidates who talked more policy while there were candidates who spoke more in ideological terms. There were candidates who were obvious appeasers/compromisers (Rubio, Bush, Kasich) and candidates who were obvious fighters (Walker, Cruz, Trump). There were multiple opinions on gay marriage, ranging from "who cares?" to "gay marriage is immoral" to "I don't oppose it but the Supreme Court should not decide". The candidates did not agree on Free Trade and most of them did not agree with Trump on foreign policy. The candidates did not agree on approaches to man made climate change. Some of them side fully with Democrats whereas some of them don't believe that man made climate change exists. There wasn't a ton of talk about taxes, because they are taking a back seat this election.

[AlabamAlum]

AA... you mean you don't want to do into the DRG negotiation process with insurance companies? Or describe how a health system might will have multiple payers with unique DRG's/plans for the same condition? Or how there are around 68,000 ICD-10 codes....

=)

No, not in this arena. Sounds too much like work. But DRG negotiation in this area is not easy. Insurers don't mind saying no and 1 primary insurer carries the lion's share of this market.

More than half the hospitals in the US are operating at a net loss on any given year. Making an average of a $200 margin per patient discharged is considered a banner year in this area. The highest earners can make a few thousand dollars per discharge, but they aren't common. Some of the highest earners, ironically, are the so-called non-profits.

And make no mistake, Americans are spoiled. We want our MRI in 45 minutes not next week. We want hospital rooms that look like hotel rooms, steak on the food trays, private sitters in private rooms and we want to walk past a marble fountain in the lobby to get our elective surgery - which was scheduled that morning.


MDs want to make 7 figures and so do the admins who run the medical center. Nurses want $55 an hour and insurers want patients who pay their premium and never get sick so the VPs of BCBS can have yachts paid for by bonus checks.



Anyway, I'm tired of this. I come here to make fun of Talent, not work.

[froot loops]

Your appeasement portion of this vast and varied coalition are the most likely to win a general election.

[entropy]

Jeff... I don't think I implied that but if I did, not my intent. I know a lot of topics were mentioned but I thought I was addressing preventative care and discussing how I don't feel FFS promotes it. Consumer demands play a much larger role in the rising costs and their lack of consequence.. imo. I do believe preventative care will help bend that cost curve. Regardless, there are problems with any system you adopt really. Just what to you want to live with. And there is no magic pill to fix either..

When it comes to unnecessary care, I think my example of blood tests is a good example... nobody is acting poorly, but a lack of coordination exists between different organizations. It was just an example of opportunity in the current system. I wasn't trying to assign fault factors to the rising costs. That also doesn't mean opportunity doesn't exist. And.. I do believe most doctors are in their roles because they want to help. I'd never suggest otherwise..

Hope that made sense..

anyways.. have a good Friday.

[froot loops]

I thought at first AA had 35 dollars an hour for nurses. That was cheap. I wish it was 55 dollars an hour, with the crap my wife deals with it would still be cheap.