Miscellaneous And Off Topic Subjects

[froot loops]

Or we have the Terri Schiavo thing and the culture warriors rush in and as a result we spend tons of money keeping alive people who are actually ready to go.

I don't know if it's that. I haven't done any study, I'm sure talent will post the definitive proof eminating from NRO but I think it's other things. My wife has been a ICU for 20 years, I've heard the stories for 20 years. There are common denominators in giving too much care at end of life situations.

1. Absent any no code orders, they actually have to do everything to keep someone alive.

2. Some families want everything done, even if it is futile. This is more of a minority.

3. Other families will not want everything done, but sometimes it takes time for these members to get in. In the meantime all kind of procedures are done.

4. Doctors will generally order everything even if it isn't needed. It definitely isn't to add to the bill but it is just a matter of them trying to save the life.

I don't know how much of that accounts for those stats, but I would say it is pretty expensive. The solution wouldn't involve death panels or waiting lines.

[entropy]

are you sure about #4... because both private insurance and medicare would disagree with you.

[THE_WIZARD_]

So with auto insurance...let's do single payer there too...shift the burden of high premium irresponsible drivers to the responsible low premium paying drivers...makes perfect sense to me...in fact let's do that with every type of insurance what the hell...

Socialism...it's nirvana!

[entropy]

I'd propose that health systems historically have spent more time and money on generating revenue than managing costs and delivering efficient care across the continuum.

Some of that is changing now thanks actually to Meaningful Use legislation by the last two presidents. I know many doc's don't like it and many feel they're being forced to do things instead of focusing on care, but I do think cost and results are now a bigger factor than they were before MU legislation. jmo

[THE_WIZARD_]

I'd propose you need to STFU

Ent:

hello

[THE_WIZARD_]

Did all you nutjobs vote for Sanders?

[froot loops]

Well, you have two ready-made test groups, Froot. You're very staunchly in favor of Medicaid expansion. It will be interesting to compare Expansion States to Non-Expansion States. Initially, at least in terms of mortality, the N-E States are doing better. I have no idea how those numbers will change over the course of several more years. But, I am certain that if the N-E States continue to produce data comparable (or ahead of) Expansion States that your response will be some sort of snarky rhetorical question.

1. I'm on a phone, I'd have to see these studies he is referencing. I'm not definitively saying the guy may be cherry picking stuff but I'm leery of an Op-ed from NRO to give an unbiased viewpoint.

2. Maybe we're going about it wrong, maybe coverage and preventive care for the poor is more than we as a society can afford.

3. My question was not a snarky rhetorical question, it was a snarky question. You posted the article, I think you think it supports your viewpoint. You liked that part of the article. A logical question is that maybe coverage for the poor doesn't matter. Clearly the GOP thinks thats, they are slashing Medicaid funding.

4. I'm sorry about the snarky questions, but really snark is your thing and sometimes when I ask you a specific you respond with true rhetorical questions. It's like trying to nail down jelly.

[Wild Hoss]

I'm all for a death panel...determining Talent's fate...

...with lobbyists!

[froot loops]

are you sure about #4... because both private insurance and medicare would disagree with you.

That's one I'm positive about. The private insurance or medicare may not pay for it, but if the doctor wants a CT scan at 3 in the morning, it's getting done. Even if it's futile. If my wife has one complaint it mostly about #4.

[entropy]

So I'm a health system and I have a doc who is providing tests for patients who have insurance, but insurance wont' cover... how long will they be around?

I'm a doc who owns my own practice.. am I providing free services to those with insurance?


I'm not talking about those without... Nor am I talking about mistakes or disagreements between systems and payers. I'm saying they don't willfully provide tests knowing insurance won't pay. (Only exception to this is the ER.. they react and stabilize before all else if required.)

Now, think about how many coders health systems have and how often they pay 3rd parties to help them collect on old AR or have issues with claims. How many places ask for your insurance after care? They know what will be paid before your appointment starts, they change coding for rejections and they negotiate like all heck for what is covered and what is not..

[iam416]

You posted the article, I think you think it supports your viewpoint.

I posted the article as an alternative viewpoint. Like you, I factor in the source and the inherent flexibility of statistics.

[entropy]

Froot.. If you're under some type of bundled payment plan through your insurance, that gives the doc more flexibility, but there is still boundaries. You won't get a CT chest scan for a broken ankle just because the doctor notices you're a smoker and thinks you should get one.

Now in the past, I believe.. actually I know Insurance and Medicare/Medicaid paid for a lot more. There was more of a sense of "if the doctor needed it" it was covered. Over time that has changed. They stopped reimbursing things like falls or unnecessary procedures which has changed behaviors. But that has been an evolution since the 90's, imo. So depending upon insurance, it may be felt at different speeds. I've told hoss this story a few times, but when my wife worked at the Fed, our care was different than after she left.. same health system. It was eye opening. Fed at that point still paid for everything.

[hack]

I think if you factored in the source, in a general sense, you'd be posting less NRO. It's not that hard to poke holes in what they do. One could consider it part of a balanced media diet. At best. But might as well just read The Economist. You get the same basic world view but without the clickbait.

[entropy]

hack.. you don't like the economist?

[froot loops]

Froot.. If you're under some type of bundled payment plan through your insurance, that gives the doc more flexibility, but there is still boundaries. You won't get a CT chest scan for a broken ankle just because the doctor notices you're a smoker and thinks you should get one.

I'll tell her she is wrong next time. My example is about end of life and was clearly stated. Broken ankles aren't ICU cases. I'm talking real end of life, like they probably won't make it through the week, but we are going to do everything, included wheeling the patient down to get a CT scan at 3 in the morning.