Health care cost

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CambieMD

cambiemd
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I have heard a lot of talk about health care reform and universal health care. Left out in all of this debate is cost containment and the elimination of waste.
Any talk about health care reform should be coupled with cost control.

Medical tourism will continue to increase as long as the cost of health care in the US continues to rise. The numbers of the uninsured will continue to rise as well.

Please see enclosed article. I realize that this topic has been covered adnosium. I included the article because it is about surgical procedures being performed abroad for a fraction of what they cost in the U.S. This practice can possibly impact us in the future.

http://www.cnn.com/2009/HEALTH/03/27/india.medical.travel/index.html

Cambie

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I have heard a lot of talk about health care reform and universal health care. Left out in all of this debate is cost containment and the elimination of waste.
Any talk about health care reform should be coupled with cost control.

Medical tourism will continue to increase as long as the cost of health care in the US continues to rise. The numbers of the uninsured will continue to rise as well.

Please see enclosed article. I realize that this topic has been covered adnosium. I included the article because it is about surgical procedures being performed abroad for a fraction of what they cost in the U.S. This practice can possibly impact us in the future.

http://www.cnn.com/2009/HEALTH/03/27/india.medical.travel/index.html

Cambie

I hate articles like this. They make a point of blaming physician salaries for high costs in the US:
TFA said:
The salary of a U.S. surgeon is five times that of a surgeon in India. "We [surgeons in India] want to make a profit, but we don't want to profiteer. We don't want squeeze people and I think American industries should also think that way," Jha said.
They're essentially accusing greedy American doctors of profiteering. As we all know physician salaries are barely a blip on the radar of realistic assessments of why healthcare costs so much in the United States. (To say nothing of how the extraordinary educational costs are borne by the physicians themselves in the US, and paid off over many years of practice.)

They also gloss over the risks. I've taken care of patients who've just returned from their medical tourism trips with lifethreatening complications from inexcusable malpractice or outright fraud.

Medical tourism is a distracting irrelevancy to the national healthcare debate.


What's really missing from the discussion is an acknowledgement that the system is already running at capacity. Congress and our fearless leader can give everyone "free" healthcare with the stroke of a pen, but they can't legislate a few thousand more physicians & surgeons into existence. Today, in many areas, even people with excellent insurance can't get a routine appointment with certain specialists in less than a month.

Where are we going to get all this extra capacity to serve the hordes of today's uninsured? They're ready to accept their god-given inalienable right to free healthcare. I guess all those greedy doctors making 5x what their non-profiteering Indian colleagues should just suck it up and keep their clinics open through the weekend, too. Walk-ins accepted until midnight.
 
I hate articles like this. They make a point of blaming physician salaries for high costs in the US:...They also gloss over the risks...
Medical tourism is a distracting irrelevancy to the national healthcare debate...What's really missing from the discussion is an acknowledgement that the system is already running at capacity...They're ready to accept their god-given inalienable right to free healthcare. I guess all those greedy doctors making 5x what their non-profiteering Indian colleagues should just suck it up and keep their clinics open through the weekend, too. Walk-ins accepted until midnight.

Great post. Couldn't agree more.

So what's the answer for cost-containment then? Does it all start with tort reform? I sure as hell know it ain't Medicare nickel and diming every single angle wrt medical care as possible. I had a nice chat with a Coding Specialist the other day which was very revealing :eek:
 
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Great post. Couldn't agree more.

So what's the answer for cost-containment then? Does it all start with tort reform? I sure as hell know it ain't Medicare nickel and diming every single angle wrt medical care as possible. I had a nice chat with a Coding Specialist the other day which was very revealing :eek:

I know, it's so stupid. Like the whole "urosepsis" thing. Medicare/insurance companies are all of a sudden saying it isn't a "real" condition. I guess you have to specifically state "UTI" with "sepsis" or something like that. Why are we letting petty lawyers determine medical jargon, among other things?
 
I'll tell you another thing that drives up the cost. I just did a case today on an 80yo man who was transfered from an outside hospital. We get a fair number of these and this guy like most came without the lab work performed at the outside hospital. So what does our ER do? They just redraw all the labs like a bunch lazy goons. I get the pt later in the day and he has 2 identical sets of labs, one from saint elsewhere and one from our fine establishment. WTF?
 
I'll tell you another thing that drives up the cost. I just did a case today on an 80yo man who was transfered from an outside hospital. We get a fair number of these and this guy like most came without the lab work performed at the outside hospital. So what does our ER do? They just redraw all the labs like a bunch lazy goons. I get the pt later in the day and he has 2 identical sets of labs, one from saint elsewhere and one from our fine establishment. WTF?

This is why it's so important for electronic records to be compatible and accessible across all hospitals...and also why it will never happen.
 
I'll tell you another thing that drives up the cost. I just did a case today on an 80yo man who was transfered from an outside hospital. We get a fair number of these and this guy like most came without the lab work performed at the outside hospital. So what does our ER do? They just redraw all the labs like a bunch lazy goons. I get the pt later in the day and he has 2 identical sets of labs, one from saint elsewhere and one from our fine establishment. WTF?

That's nothing. We'll have some services repeat full imaging studies. Because the difference between 64-slice CT and 128-slice CT make a huge difference. Neurosurgery does it all the time with MRI, even when the patient comes with the studies on a CD.
 
That's nothing. We'll have some services repeat full imaging studies. Because the difference between 64-slice CT and 128-slice CT make a huge difference. Neurosurgery does it all the time with MRI, even when the patient comes with the studies on a CD.

Exactly, we do the same thing.

I also had a 25 yo for an appy show up at an outside 24hr stay hospital with belly pain. The pt was asked about headaches or dizziness. He said he got dizzy when he stood up fast. THe ER doc ordered a head CT, after a review of the pts insurance of course.
 
Exactly, we do the same thing.

I also had a 25 yo for an appy show up at an outside 24hr stay hospital with belly pain. The pt was asked about headaches or dizziness. He said he got dizzy when he stood up fast. THe ER doc ordered a head CT, after a review of the pts insurance of course.

Also known as a "wallet biopsy". Results positive? CT of head.....results negative? Education and/or IV fluids
 
I love how many normal appendices we're taking out lately. CT is now the standard - the friggin surgeon doesn't even see the patient until they're in the OR. The CT's are over-read by the radiologist for fear of getting sued for missing the diagnosis, so we end up doing a lot of lap appy's on afebrile patients with near normal WBC's and a little mild RLQ pain.
 
I love how many normal appendices we're taking out lately. CT is now the standard - the friggin surgeon doesn't even see the patient until they're in the OR. The CT's are over-read by the radiologist for fear of getting sued for missing the diagnosis, so we end up doing a lot of lap appy's on afebrile patients with near normal WBC's and a little mild RLQ pain.

My understanding was, a negative appy rate of 10% was acceptable "back in the day"...and then the rate went down d/t CT and U/S providing radiologic evidence for every suspected appy...and now on the rise again, eh? Only now, the pts are getting irradiated and charged $$$ for their trouble :scared:
 
I'll tell you another thing that drives up the cost. I just did a case today on an 80yo man who was transfered from an outside hospital. We get a fair number of these and this guy like most came without the lab work performed at the outside hospital. So what does our ER do? They just redraw all the labs like a bunch lazy goons. I get the pt later in the day and he has 2 identical sets of labs, one from saint elsewhere and one from our fine establishment. WTF?

Dear lord this happens all the time. where i did residency anyone coming to the unit got everything redrawn, all the time.

On a side note, germane to the OP's post, I don't see medical tourism gaining a ton of ground. 1. Its a huge hassle, and lots of people don't like to travel to strange places, much less strange places for medical conditions. Follow up is a huge issue. And also, the price differential is likely to narrow some over time. I see it as a marginal issue, but you never know. Especially if our costs continue to escalate.
 
I realize it's taboo/hotbutton/verbotten/etc, but if I could change one thing about medical care provision related to cost, it would be end-of-life care. In my very limited experience, it almost seemed like some weeks, the worse the patient prognosis, the more the family wanted done.

dc
 
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