Courts Rule Against Hospital $O$ and Hospitals Want to Fight...

Nov 21, 1998
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The court presented 2017 data showing the evaluation and management reimbursement rate for new patients was $184 in outpatient clinics, compared with $109 at a freestanding physician's office, and cited Medicare Payment Advisory Commission reports that found hospitals reacted to the payment differential by buying up freestanding physician practices.

CMS Administrator Seema Verma tweeted that the ruling is a win for American patients.

"A patient shouldn't have to pay more for an outpatient department visit than a visit to a doctor's office, & on avg can save $14/visit," Verma tweeted on Friday.

The American Hospital Association said is reviewing the decision to determine next steps.
 
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Ducttape

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cant access....


nm, I found info here:
 
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SommeRiver

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Us non-millionaire anti-ballers can't afford that subscription to that website.

...but I like where this is going.

SOS differential is cruel and inhumane.
 
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cant access....


nm, I found info here:

"A panel of appellate judges on July 17 overturned a lower court ruling and held that a HHS' site-neutral payment policy that cuts Medicare payments for hospital outpatient visits can go forward."

Yes, we want HSS site-neutral payment policies to go forward. No more $O$ arbitrage and employed-MD kickbacks. Say goodbye to the 60 min CESI's and $2,000 OR bills.
 
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"A panel of appellate judges on July 17 overturned a lower court ruling and held that a HHS' site-neutral payment policy that cuts Medicare payments for hospital outpatient visits can go forward."

Yes, we want HSS site-neutral payment policies to go forward. No more $O$ arbitrage and employed-MD kickbacks. Say goodbye to the 60 min CESI's and $2,000 OR bills.

Worrying about such things is like worrying about the weather. We can't control the external forces of medicine- we just have to play with the hands we are dealt. I can't say what the future of medicine will be, but I know for damn sure there will be change.

In a few years, I will be back to being a farmer/auto mechanic. Such things are more relevant for you guys. Just be willing to adapt and accept that there will be changes you may not like.
 
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Worrying about such things is like worrying about the weather. We can't control the external forces of medicine- we just have to play with the hands we are dealt. I can't say what the future of medicine will be, but I know for damn sure there will be change.

In a few years, I will be back to being a farmer/auto mechanic. Such things are more relevant for you guys. Just be willing to adapt and accept that there will be changes you may not like.

I disagree. Doctors have been explicitly indoctrinated to believe that they can't change the system. We have learned to become helpless. Medical school does not teach professional advocacy, entrepreneurialism, or how to affect policy. Medical schools and hospitals want doctors to relinquish their professional autonomy and just fall in line. Resist the brainwashing.

I recently completed a health policy fellowship where advocacy skills were EXPLICITLY taught. Many, many professions learn these skills--the hospital industry, the nursing industry, etc. Doctors not so much. Imagine how much we could accomplish by rising up, giving the C-suite the middle-finger, and taking back control of the reins of medicine.

It starts with $O$ arbitrage schemes. I've spent a year studying them. It is the root of all evil in our health care system. Hospitals have taken things that are not theirs and have inherited things that they don't deserve.
 
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It starts with $O$ arbitrage schemes. I've spent a year studying them. It is the root of all evil in our health care system.
I might give that honor to our health insurance industry.

But it's helpful to know how our government prioritizes small and large healthcare businesses in the face of lobbying efforts.
 

Ducttape

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It starts with $O$ arbitrage schemes. I've spent a year studying them. It is the root of all evil in our health care system. Hospitals have taken things that are not theirs and have inherited things that they don't deserve.
I might give that honor to our health insurance industry.

boil it down.

$$$ is the root of all evil in our health care system - be it greedy hospitals or pharmaceutical companies or device companies or private practices or doctors.
 

SommeRiver

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boil it down.

$$$ is the root of all evil in our health care system - be it greedy hospitals or pharmaceutical companies or device companies or private practices or doctors.

Go hang a shingle out of fellowship and in 24 months let's talk about how you're doing relative to your peers.

Obviously, that is depending on where you live...

The local hospital system will buy up every PCP in the region and you'll get no referrals.

Your peers working for a local hospital system will do 2/3 your volume and collect twice what you collect for the same work.

That system buys up everything around you and if you're a bigger practice they'll buy you too, and after doing so may decide to hell with you and fire you. They may just give you a favorable contract for a year and then cut you down by 25% if they choose.

They may buy you, then COVID-19 hits and they furlough you indefinitely without pay.
 
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DOctorJay

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Go hang a shingle out of fellowship and in 24 months let's talk about how you're doing relative to your peers.

Obviously, that is depending on where you live...

The local hospital system will buy up every PCP in the region and you'll get no referrals.

Your peers working for a local hospital system will do 2/3 your volume and collect twice what you collect for the same work.

That system buys up everything around you and if you're a bigger practice they'll buy you too, and after doing so may decide to hell with you and fire you. They may just give you a favorable contract for a year and then cut you down by 25% if they choose.

They may buy you, then COVID-19 hits and they furlough you indefinitely without pay.

... and with a non-compete you're not even able to look for another job close to where you live
 
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boil it down.

$$$ is the root of all evil in our health care system - be it greedy hospitals or pharmaceutical companies or device companies or private practices or doctors.

No. It's not the insurance industry. Ditto for pharma. Different problems. Hospitals churning $O$ schemes with monkey-boy, RVU-pellet consuming providers **is** the problem. That's the problem. Fix THAT.


"The differential between Medicare payments to PBDs and independent practices was one reason that many hospitals were buying ambulatory care practices, the Medicare Payment Advisory Commission (MedPAC) told Congress. MedPAC repeatedly urged the government to establish site-neutral payments for that reason."
 

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No. It's not the insurance industry. Ditto for pharma. Different problems. Hospitals churning $O$ schemes with monkey-boy, RVU-pellet consuming providers **is** the problem. That's the problem. Fix THAT.


"The differential between Medicare payments to PBDs and independent practices was one reason that many hospitals were buying ambulatory care practices, the Medicare Payment Advisory Commission (MedPAC) told Congress. MedPAC repeatedly urged the government to establish site-neutral payments for that reason."
SOS is big big issue, but if you don't think Insurance and Big Pharma are part of the problem, C'mon
 
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No. It's not the insurance industry. Ditto for pharma. Different problems. Hospitals churning $O$ schemes with monkey-boy, RVU-pellet consuming providers **is** the problem. That's the problem. Fix THAT.


"The differential between Medicare payments to PBDs and independent practices was one reason that many hospitals were buying ambulatory care practices, the Medicare Payment Advisory Commission (MedPAC) told Congress. MedPAC repeatedly urged the government to establish site-neutral payments for that reason."
I view the SOS as a cheap band aid to the real problems. What is your plan for when hospitals shut down? Who will take care of pts without insurance coverage or Medicaid?
 
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We will have to massively re-prioritize what we spend our money on...

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Jesus what a total disaster. But will the "starve the beast" technique work with hospitals politically?

edit: just to add: although it's crazy the amount of money that is wasted on useless regs and admin, I doubt it remotely compares to the amount lost to the unpaid medical care, ancillaries, etc.
 
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Jesus what a total disaster. But will the "starve the beast" technique work with hospitals politically?

Yes, if do the next important thing: Prohibit hospitals from putting non-competes and corona-triggers in their employment contracts. They keep MD/DOs enslaved with their non-competes. Time to emancipate employed doctors everywhere!

Site Neutral Payment Reform + Elimination of Hospital Employed Non-Competes = Rebirth of Independent Medical Practice


"Non-compete clauses can have lasting consequences on doctors and the communities they serve. Depending on the language, a non-compete can turn termination into lengthy involuntary unemployment. A physician’s non-compete, for instance, may prevent them from working at any rival hospital or clinic in their community, state or region for one or two years after dismissal. Accepting a new job when subject to this contract can invite cease-and-desist letters and threats of litigation from their previous employer. Not only does this hurt their ability to make a living, but this forced unemployment can sever physician-patient relationships that have been developed over many years and create a community-wide shortage of desperately needed doctors"

Every employed-MD needs to walk into the C-suite and say, "I'm going to cut your F*ck*ng Balls off!"
 
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Sorry, but what does $O$ represent?


Ah...$O$ is the magic in Merlin's wand, it's the Grand Elixir, it's the Ambrosia of our health care system, it's the secret sauce that marinates and cooks the books in every hospital in our land...it's the site of service differential. Simply, people pay different prices for health care services based upon WHERE a service is rendered. Want to be a low-cost leader? Treat patients in the office. Want to be force-fed RVU pellets like a goose on a foie gras farm? Do your procedure in a hospital's OR...
 

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