Death Spiral??

IPSIS: Formerly the Spine Intervention Society
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PainDrain said:
First off, if you are donating 100k per year of true charity you must be making a killing and you should just STFU.
Second, nice humblebrag.
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LMAO
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PainDrain said:
First off, if you are donating 100k per year of true charity you must be making a killing and you should just STFU.
Second, nice humblebrag.
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please don't become a ductape disciple.... the guy is a tool... and yes I donate a lot to charity and religion, sorry if that offends you. And yes I am making a killing, and yes I am a much better person and physician than ducttape. and no I don't need pain rounds to prove my moral code, and to antagonize anybody that does now spew the liberal/progressive nonsense with every argument.....
 
ductape have you ever considered that I am a moral, ethical, honest, and caring physician that does REALLY WELL and gets tons of referrals from patients, physicians, and families directly, and that I deserve everything I earn. And that you are a miserable, combative, and narrow-minded human with nothing better to do than to troll the internet for fights.... consider that for a second... have a great day, I know I am...
 
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i do not love big insurers.
i do not love big pharma.
i do not love hospital systems.

i do like the administrators who are in charge of this system.
i do like the history of the institution in the city i have spent 27 years living in.
i do like the fact that i do not have to make decisions based on finances. yes, someone makes that decision for me, and i gladly accept criticism for this inaction/action. but it does, in my mind, allow me to look at what is right for patients along with what is right for myself.

this is not exclusive to HOPD. obviously any PP can be set up in this manner. but i like to think that i set it up working closely with the admin , before i started, with as much a focus on community benefit as the oversized ever greedy wallets of the hospital and myself.



and yes, stim, i did consider your last post. long before you ever imagined using it.
 
Singer payer, funny you should
Stim4me said:
ductape have you ever considered that I am a moral, ethical, honest, and caring physician that does REALLY WELL and gets tons of referrals from patients, physicians, and families directly, and that I deserve everything I earn. And that you are a miserable, combative, and narrow-minded human with nothing better to do than to troll the internet for fights.... consider that for a second... have a great day, I know I am...
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Yea Stim - the guy that got banned for picking fights and we actually held a wake for - as the voice of reason on this forum:)
Dude you are too funny.
 
101N said:
Singer payer, funny you should


Yea Stim - the guy that got banned for picking fights and we actually held a wake for - as the voice of reason on this forum:)
Dude you are too funny.
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just to clarify, you peeps did not ban me... you don't have the power to do that, especially trolls like ductape...

I'm surprised none of you are offended by ductappe's shot at my religion... I thought he was some noble being that a handful of you worship, he's more like a prepubescent child in an adult world.
 
whats the Golden Temple? i find one in india, and then one in Birmingham alabama, and one in NY. but none that are related to a religion. Did he take a shot at your religion?

im fascinated by where this thread is going...
 
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Jcm800 said:
whats the Golden Temple? i find one in india, and then one in Birmingham alabama, and one in NY. but none that are related to a religion. Did he take a shot at your religion?

im fascinated by where this thread is going...
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sikh-pilgrim-golden-temple-amritsar-india.jpg
 
why do they need 100k of stim's money? the temple is made of gold for crying out loud!
 
That dude's got an aneurysm.
 
101N said:
That dude's got an aneurysm.
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the dude in the picture or stim?

i think thats an AV shunt for dialysis. rhabdo from his marathon mediation sessions.....
 
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Stim4me said:
just to clarify, you peeps did not ban me... you don't have the power to do that, especially trolls like ductape...

I'm surprised none of you are offended by ductappe's shot at my religion... I thought he was some noble being that a handful of you worship, he's more like a prepubescent child in an adult world.
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You and Bedrock share same religion, 911s.
 
the guy is a tool...
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more like a prepubescent child in an adult world
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trolls like ductape...
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sticks and stones dude.

fyi i never insulted your religion. in fact, i never noted your religion. do a google search on "golden temple" - chinese restaurants are on the list. and everyone on this board knows how much i love chinese food
 
Ducttape said:
sticks and stones dude.

fyi i never insulted your religion. in fact, i never noted your religion. do a google search on "golden temple" - chinese restaurants are on the list. and everyone on this board knows how much i love chinese food
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donate to the Golden Temple in Amritsar, India. They feed 100,000 people per day for free... show your nobility. may god be with you.
 
thanks for the suggestion, but...

i currently donate to the ADA, Honor Flight, Vietnam Vets, Michael J Fox Foundation, and 2 separate high school scholarship funds...
 
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hyperalgesia said:
Corrected
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Sikhism is monotheistic with karma system; with the goal of leading a virtuous life to attain godly state. Hinduism is polytheistic with a karma system(gods)...
 
SSdoc33 said:
this is why there continues to be a SOS differential.

without the SOS differential, hospitals go belly-up.

this may be a good or bad thing, depending on who you ask.
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Private practice and hospital employed physicians are the same in this regard. Private practice physicians generally shy away from Medicaid because of the low reimbursement coupled with the psycho/social issues in this patient population.

Take away the site of service differential, and the hospital employed physician now has low reimbursement (decreased compensation package), and will not want to accept Medicaid.

While I am in favor of the hospital being supported financially to treat the indigent population, I am not in favor of a broad site of service differential. Too much wiggle room, allowing for profiteering and establishment of control in a medical community.
 
Disciple said:
Take away the site of service differential, and the hospital employed physician now has low reimbursement (decreased compensation package), and will not want to accept Medicaid.
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That's a good point. If you ask the hospital employed docs to accept a salary cut to continue serving Medicaid pts, would they accept that or prefer not to accept Medicaid any more?
 
disciple, hospital employed physicians most likely will be forced to accept Medicaid, because the system otherwise takes Medicaid. they most likely will have no choice, and might only be able to influence the % of patients that are Medicaid.

and hyperalgesia, with your question, the situation where this might be applicable is a currently employed hospital doc who is told that his salary will be garnished because of loss of SOS differential. i highly doubt any options would be extended - his salary will be reduced, but he has no choice on deciding whether to take Medicaid. his decision is whether to stay or not.
 
Ducttape said:
disciple, hospital employed physicians most likely will be forced to accept Medicaid, because the system otherwise takes Medicaid. they most likely will have no choice, and might only be able to influence the % of patients that are Medicaid.

and hyperalgesia, with your question, the situation where this might be applicable is a currently employed hospital doc who is told that his salary will be garnished because of loss of SOS differential. i highly doubt any options would be extended - his salary will be reduced, but he has no choice on deciding whether to take Medicaid. his decision is whether to stay or not.
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That's what I'm getting at. The hospital can offer a good salary/benefit package to the doctor because of the site of service differential. Without it, it would be difficulty to retain a capable, high quality individual to service the indigent.

So, the question is, would you rather that hospitals have that money--and the profiteering/negative consequences that come with it, or should it go to someone like drusso who wants to the help the community through private practice.
 
Disciple said:
So, the question is, would you rather that hospitals have that money--and the profiteering/negative consequences that come with it, or should it go to someone like drusso who wants to the help the community through private practice.
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Walmart destroyed Main Street by duping consumers into "everyday low prices." The same is happening in health care. Just pay what it costs to take care of a Medicaid population, or "give up the ghost" and admit that Heath care is not a right--it's a service like accounting, plumbing, etc...
 
The problem is that there is already a lack of access of health care to the group of patients that are most vulnerable. There is plenty of access for patients with insurance.

Of course, being a liberal, i do feel this population critically needs such access, in a manner that provides safe care and does not increase risk to society as a whole (ie unmitigated drugs). If getting rid of SOS differential means that hospitals abandon medicaid, then imo this is not a good option, in many ways.
 
So, you're saying that accepting the negative consequences of site of service differential, to be able to provide access to the Medicaid population, is an acceptable compromise.

If not for politics, better solutions could be explored.
 
Disciple said:
So, you're saying that accepting the negative consequences of site of service differential, to be able to provide access to the Medicaid population, is an acceptable compromise.

If not for politics, better solutions could be explored.
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Please consider how it is negative. Is SOS differential primarily negative because in-office proceduralists cant get paid the same amount? ( in just rephrasing the argument now ).

Maybe, instead of trying to shoot down SOS differential by saying it is too large, we should advocate that office based pay is being inadequately reimbursed, which i believe it is...

However, Would that encourage enough private practice providers to accept and treat Medicaid?

Somehow, oddly, i remain skeptical.
 
It's negative in that it allows manipulation of regional markets and profiteering. In other words strong-arming of doctors.

There is access for Medicaid patients, but the medical community becomes bound by the protocols of the prevailing hospital system.

Depends whether one thinks that is a good trade-off, or if there are better solutions.

In my opinion, there is a near zero percent chance that reimbursement for office based work would be significantly increased, without cuts elsewhere.

If the focus now is to be on savings, savings, savings, through pseudo quality measures, decreased utilization and decreased reimbursement for doctors,

then the discussion needs to include hospitals and site of service differential. And I think more and more, this is coming into the public eye.
 
If there is anything to be learned, it is that those who are in position of power - who are aware of their authority - are not likely to give it up. Since nursing and admin have much to lose if SOS differential disappears, i contend that it will never go away.

There will always be a nursing advocate who will point out that ASC snd HOPD provide safer care because Nursing is involved, regardless of the actual truth...
 
Ducttape said:
If there is anything to be learned, it is that those who are in position of power - who are aware of their authority - are not likely to give it up. Since nursing and admin have much to lose if SOS differential disappears, i contend that it will never go away.

There will always be a nursing advocate who will point out that ASC snd HOPD provide safer care because Nursing is involved, regardless of the actual truth...
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HOPD differential is about to change
http://www.squirepattonboggs.com/~/...dget-act-of-2015-and-hopd-payment-reforms.pdf
 
lonelobo said:
HOPD differential is about to change
http://www.squirepattonboggs.com/~/...dget-act-of-2015-and-hopd-payment-reforms.pdf
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Here is the crux of the issue: "Revisions to Hospitals’ Reimbursements? – Perhaps the strongest justification for site-specific payments is the fact that hospitals often use the increased revenue to subsidize other patient care services that are inadequately funded by Medicare and private payers. The Alliance for Site-Neutral Payment Reform has admitted as much, telling Congress that, once site-neutral payment reforms are implemented, “alternative funding sources may be required to secure access to this [currently subsidized] care.” As Congress continues to consider eliminating the creative reimbursement strategies hospitals have been pursuing, it will be interesting to see whether Congress addresses the true elephant in the room: Medicare’s increasingly inadequate reimbursement scheme for hospitals."

This is a basic equity issue: Where's my government subsidization/bail-out?
 
this really only affects the new HOPD builds. existing ones are grandfathered in, as are ones that are within 250 yards of the hospital itself (which I is what i advocated a while ago).
stopping new HOPD from starting up is interesting, but its not changing those existing HOPD.

ASCs are still unaffected, and still bill considerably more than office based...


also, do you take Medicaid? your clinic's government bailout would have been in the form of HOPD or ASC fees. if you don't, im guessing you don't qualify...
 
My issue is that there are so many negative/unfair market influences by government bodies to prop up this house-of-cards. The SOS differential because, if we didn't have it, "Hospitals can't survive with what we pay them!" States' use of Certificates of Need because hospitals can't survive without an unfair competitive advantage. My point is, these "fixes" to problems that we have created are just causing other problems.
 
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Ducttape said:
this really only affects the new HOPD builds. existing ones are grandfathered in, as are ones that are within 250 yards of the hospital itself (which I is what i advocated a while ago).
stopping new HOPD from starting up is interesting, but its not changing those existing HOPD.

ASCs are still unaffected, and still bill considerably more than office based...


also, do you take Medicaid? your clinic's government bailout would have been in the form of HOPD or ASC fees. if you don't, im guessing you don't qualify...
Click to expand...

What it will do is it will slow acquisition of some ASCs and Private practices by hospitals
http://www.modernhealthcare.com/article/20151031/MAGAZINE/310319971
 
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