Making more $$$ through healthcare reform

[TILalot]

Does anyone else think that doctor's will eventually make MORE money through this? Think about it, if insurance companies have to spend a minimum of 80% of their premiums for actual care then wouldn't they want the doctors to charge more?

I.E. if a standard check-up is $80 then the insurance can keep $20 of its premiums. But if the check-up is now $160, then the insurance can keep $40 of it's premiums AND charge for higher premiums. More money into the system lets them still keep 20%, but it's a higher amount of money in totality.

What am I missing?

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[NYEMMED]

Does anyone else think that doctor's will eventually make MORE money through this? Think about it, if insurance companies have to spend a minimum of 80% of their premiums for actual care then wouldn't they want the doctors to charge more?

I.E. if a standard check-up is $80 then the insurance can keep $20 of its premiums. But if the check-up is now $160, then the insurance can keep $40 of it's premiums AND charge for higher premiums. More money into the system lets them still keep 20%, but it's a higher amount of money in totality.

What am I missing?

Eventually the Healthcare reform will cause more doctors to earn less especially in primary care. There are hidden things in the bill that make it this way. 1) Residents will now have to pay federal taxes, and withholdings. 2) Less $$$ is available by government loans due to the student loan reform section of the healthcare reform bill (less money allowed to be loaned plus higher interest rates = a lot more money to pay back) 3) less funding for residencies 4) Insurance companies can deny a lot more to make up for their losses, making care worse for your patients and causing you to loose money by not performing procedures. 5) 80% has to go to care, but that is not defined, there are already loopholes that were found and announced and the system will continue at status quo. 6) more denied procedure thanks to insurance companies leads to unhappy patients = more lawsuits, less appointments more court costs and less earnings

 

[NYEMMED]

Eventually the Healthcare reform will cause more doctors to earn less especially in primary care. There are hidden things in the bill that make it this way. 1) Residents will now have to pay federal taxes, and withholdings. 2) Less $$$ is available by government loans due to the student loan reform section of the healthcare reform bill (less money allowed to be loaned plus higher interest rates = a lot more money to pay back) 3) less funding for residencies 4) Insurance companies can deny a lot more to make up for their losses, making care worse for your patients and causing you to loose money by not performing procedures. 5) 80% has to go to care, but that is not defined, there are already loopholes that were found and announced and the system will continue at status quo. 6) more denied procedure thanks to insurance companies leads to unhappy patients = more lawsuits, less appointments more court costs and less earnings

Not to mention the drastic cuts in the medicare/ medicaid reimbursement system, and pay rates. Which will lead to doctors and primarily primary care doctors getting less. In the baby boomer age, many patients are medicare patients. Those cuts will affect all doctors pockets, and you are bound to the terms, whether or not the restrictiveness of exams, diagnostics procedures is good for your patient. Makes it hard to do the best for your patient as possible

 

[Atom bum]

Not to mention the drastic cuts in the medicare/ medicaid reimbursement system, and pay rates. Which will lead to doctors and primarily primary care doctors getting less. In the baby boomer age, many patients are medicare patients. Those cuts will affect all doctors pockets, and you are bound to the terms, whether or not the restrictiveness of exams, diagnostics procedures is good for your patient. Makes it hard to do the best for your patient as possible

I don't think medicare cuts are part of the reform. They have been fighting that for years and years.

 

[NYEMMED]

I don't think medicare cuts are part of the reform. They have been fighting that for years and years.

You are right the cuts have been band-aided repeatedly but unfortunately this bill also did not address them. The cuts to medicare in this bill are cuts to medicare advantage specifically, which provide extra reimbursement, and extra benefits, this will now be phased out

 

[masscrash]

This new bill really scares me as an upcoming medical school. I really really hope that someone overturns it. It was a garbage bill that was rushed and not thought through. I agree with NYEMMED. You will probably get paid less and expected to do more.

 

[masscrash]

Now you guys got me all upset. I was just fine living in my ignorance just hoping for the best. But now I'm thinking about it and getting all pissed.

 

[Atom bum]

Surely you agree that we need some sort of reform?
To be honest, I don't care if I get paid the same as a teacher for example, but only if there is some sort of assistance with student loans.

No need to flame me for my opinion, I know that doctors go through a lot of training and perform a highly specialized service that deserves compensation, I'm just saying I don't really care about money so it doesn't bother me personally.

 

[Dr Oops]

I don't think medicare cuts are part of the reform. They have been fighting that for years and years.

the cuts in medicare payments are apart of the plan, its how some of the funding for the changes were proposed to be paid for. They have been pushed back so far.

Also cuts in medicare funding to the tune of 500 million were also part of the bill.

 

[JeetKuneDo]

Surely you agree that we need some sort of reform?
To be honest, I don't care if I get paid the same as a teacher for example, but only if there is some sort of assistance with student loans.

No need to flame me for my opinion, I know that doctors go through a lot of training and perform a highly specialized service that deserves compensation, I'm just saying I don't really care about money so it doesn't bother me personally.

With salaries similar to teachers, if it ever happens, docs will only be like 10k or so above emts. That'd be interesting.

 

[Atom bum]

With salaries similar to teachers, if it ever happens, docs will only be like 10k or so above emts. That'd be interesting.

You make a good point. I don't think it will happen either and your example is a good reason why.
I just don't want to see us future physicians ignoring other aspects of health-care reform so we can focus on the compensation.

 

[masscrash]

Surely you agree that we need some sort of reform?
To be honest, I don't care if I get paid the same as a teacher for example, but only if there is some sort of assistance with student loans.

No need to flame me for my opinion, I know that doctors go through a lot of training and perform a highly specialized service that deserves compensation, I'm just saying I don't really care about money so it doesn't bother me personally.

we are in definite need of a reform but not by greedy money hungry *****ic nimrods who try to push it through just to say they did something. I mean does anyone honestly believe that Nancy Pelosi and her half-witted click of bill writers had the patients interest in mind when writing the reform, let alone the doctors. Or was it more realistically the interests of all the people they wanted to back the bill. I don't sympathize with the insurance companies but what the government did to them wasn't right. They shouldn't be able to go into a business and demand that they offer better products for less money. The insurance company is like a casino, you go to them betting your going to get sick and they bet your going to stay healthy. Based on your risk factors they make the odds and charge you a price. Now they are supposed to pay out for everyone even the already sick. (don't get me wrong I feel for people with chronic disease, I have them in my family. I'm just making a point that THEY didn't think it through) Thats like sitting down at a black jack table and every hand is a winner. How long is the casino going to stay in business? We can't afford to have the insurance companies to go out of business so who is going to save them? Government! Then who gets to call the shots? Government! We need reform but reform that will work. Mark my words this will end up very badly if it continues.
Disclaimer: I have not read the bill and I welcome any corrections of my misconceptions by anyone who has.
Atom Bum I do agree with you that I am not doing it for the money, but I am giving up prime years of my life, years of salary I could be making at other jobs, years of retirement savings, time away from my family and i am putting myself in a mountain of debt. I would like to be Fairly compensated.

 

[Tekar]

This new bill really scares me as an upcoming medical school. I really really hope that someone overturns it. It was a garbage bill that was rushed and not thought through. I agree with NYEMMED. You will probably get paid less and expected to do more.

This bill was not rushed through, it's been in the planning process for years. It's got many of the stipulations Republicans posed against Clintoncare in the 90's. Don't listen so much to the talking bloviators raising a stink. Obama caved on so much of this legislation that watering it down doesn't even begin to describe it.

You should not fear this legislation for what the government tried to do, you should fear it for what the insurance companies actually did. Read the book Deadly Spin. It'll be worth your time.

 

[Tekar]

Does anyone else think that doctor's will eventually make MORE money through this? Think about it, if insurance companies have to spend a minimum of 80% of their premiums for actual care then wouldn't they want the doctors to charge more?

I.E. if a standard check-up is $80 then the insurance can keep $20 of its premiums. But if the check-up is now $160, then the insurance can keep $40 of it's premiums AND charge for higher premiums. More money into the system lets them still keep 20%, but it's a higher amount of money in totality.

What am I missing?

The only group of physicians that have a hope of making more money from this legislation are the primary care providers by making everyone buy insurance. If everyone has insurance, that means everyone is able to see a doctor before they run to the ER. Plus, it's causing lots of babyboomer docs to run for the hills creating a new type of shortage...physician exodus. Good riddance. Lemme leave you a box of cards to hand to your patients before you hang the closed sign.

The 80% thing is complete and total garbage. Take an accounting class to learn how ridiculous the concept of mandated spending is to those trying to milk more money out of insurance. All they will do is recategorize transactions they didn't count but were doing anyway into some form of a "patient care" category.

News flash people, nothing is going to change. You're still going to continue getting screwed by insurance companies who pay millions of dollars to make you think it's the government screwing you. It's not. It's the billionaires who want to be bigger billionaires. Medicare pays it's top executive 175k. CIGNA paid their top executive 24 million. You do the math.

 

[Atom bum]

we are in definite need of a reform but not by greedy money hungry *****ic nimrods who try to push it through just to say they did something. I mean does anyone honestly believe that Nancy Pelosi and her half-witted click of bill writers had the patients interest in mind when writing the reform, let alone the doctors. Or was it more realistically the interests of all the people they wanted to back the bill. I don't sympathize with the insurance companies but what the government did to them wasn't right. They shouldn't be able to go into a business and demand that they offer better products for less money. The insurance company is like a casino, you go to them betting your going to get sick and they bet your going to stay healthy. Based on your risk factors they make the odds and charge you a price. Now they are supposed to pay out for everyone even the already sick. (don't get me wrong I feel for people with chronic disease, I have them in my family. I'm just making a point that THEY didn't think it through) Thats like sitting down at a black jack table and every hand is a winner. How long is the casino going to stay in business? We can't afford to have the insurance companies to go out of business so who is going to save them? Government! Then who gets to call the shots? Government! We need reform but reform that will work. Mark my words this will end up very badly if it continues.
Disclaimer: I have not read the bill and I welcome any corrections of my misconceptions by anyone who has.
Atom Bum I do agree with you that I am not doing it for the money, but I am giving up prime years of my life, years of salary I could be making at other jobs, years of retirement savings, time away from my family and i am putting myself in a mountain of debt. I would like to be Fairly compensated.

Sigh... You can't blame this on "Nancy Pelosi and her bill writers" and frankly your pejorative sentiment betrays a definite bias. Do you honestly believe the new house is going to do a better job?

Unfortunately my omniscience pills have been an abject failure so I don't know how to fix the situation, but I do know that we need to keep it civil so we can work together.

 

[Tekar]

With salaries similar to teachers, if it ever happens, docs will only be like 10k or so above emts. That'd be interesting.

Seriously??? You need to take off the aluminum hat. Doctors will never make as little as teachers. If you're paranoid enough to believe that to be a reality, I'm not sure you should be a doctor. You'll be thinking that all of the 1 in 1,000,000 diseases you learn about in medical school will all show up to your door and fully convinced that everyone one of your patients is going to sue you so you should just order 15k worth of imaging studies and labs by protocol when they make their appointment.

Come on...

 

[Atom bum]

Seriously??? You need to take off the aluminum hat. Doctors will never make as little as teachers. If you're paranoid enough to believe that to be a reality, I'm not sure you should be a doctor. You'll be thinking that all of the 1 in 1,000,000 diseases you learn about in medical school will all show up to your door and fully convinced that everyone one of your patients is going to sue you so you should just order 15k worth of imaging studies and labs by protocol when they make their appointment.

Come on...

He was responding to me and I was just trying to make a point.

 

[Tekar]

Sigh... You can't blame this on "Nancy Pelosi and her bill writers" and frankly your pejorative sentiment betrays a definite bias. Do you honestly believe the new house is going to do a better job?

Unfortunately my omniscience pills have been an abject failure so I don't know how to fix the situation, but I do know that we need to keep it civil so we can work together.

This is the exact argument the insurance industry uses to make people believe Nancy Pelosi is the problem. She's not the problem. The people paying millions of dollars to make you believe she is the problem are the problem.

 

[Tekar]

He was responding to me and I was just trying to make a point.

Point taken. Consider this to be redirecting that comment to you.

 

[Atom bum]

Point taken. Consider this to be redirecting that comment to you.

To counter, I was merely trying to point out that we should not be focusing on compensation. There are more important aspects of health care reform than how much money we make.

I will restate that if I had student loan help and protection against lawsuits I wouldn't care if I made as much as a teacher.

Edit:

 

[Tekar]

To counter, I was merely trying to point out that we should not be focusing on compensation. There are more important aspects of health care reform than how much money we make.

I will restate that if I had student loan help and protection against lawsuits I wouldn't care if I made as much as a teacher.

And I will reiterate that even begin to associate physician compensation to the absurdly low teacher pay is insulting to teachers. My wife stood before her OBGYN complaining about why I wanted to go to medical school when their compensation was steadily going down. She replied "well I don't think it's quite 35k." Her OBGYN felt like an ass. Rightfully so. Even as good of a doctor as she is. It's important to keep things in perspective.

Compensation isn't about money, it's about 11 years of investment before we're allowed to talk to a patient without someone signing off on us. Saying you aren't going into medicine for the money is like a teacher saying they don't care about the summers. Sure, it isn't the only thing, but it's a nice perk.

 

[Atom bum]

And I will reiterate that even begin to associate physician compensation to the absurdly low teacher pay is insulting to teachers. My wife stood before her OBGYN complaining about why I wanted to go to medical school when their compensation was steadily going down. She replied "well I don't think it's quite 35k." Her OBGYN felt like an ass. Rightfully so. Even as good of a doctor as she is. It's important to keep things in perspective.

Compensation isn't about money, it's about 11 years of investment before we're allowed to talk to a patient without someone signing off on us. Saying you aren't going into medicine for the money is like a teacher saying they don't care about the summers. Sure, it isn't the only thing, but it's a nice perk.

Sorry to be dense, but I don't understand your anecdote. What did the OBGYN mean by "well I don't think it's quite 35k."

Also, I think you are getting too stuck on this which is unfortunate because I was trying to stay away from focusing on compensation.
I guess it is an important topic though...

 

[Tekar]

Sorry to be dense, but I don't understand your anecdote. What did the OBGYN mean by "well I don't think it's quite 35k."

Also, I think you are getting too stuck on this which is unfortunate because I was trying to stay away from focusing on compensation.
I guess it is an important topic though...

That was my wife's response to her OBGYN. My wife teaches High School English and was making about that (as was I as a high school sped teacher) when I decided to change careers.

 

[JeetKuneDo]

Sorry to be dense, but I don't understand your anecdote. What did the OBGYN mean by "well I don't think it's quite 35k."

Also, I think you are getting too stuck on this which is unfortunate because I was trying to stay away from focusing on compensation.
I guess it is an important topic though...

I'll first say that I haven't read this bill that we're all talking about. I do think that compensation is a very important topic if the bill's intent is to somehow reduce it. I know this current system isn't the best, and have no solutions on how to fix it. However, I do think that there are other ways to make the system more efficient than reducing physician compensation, no matter how little. So yeah, I think compensation shouldn't be a focus either. It shouldn't even be mentioned, unless we're talking about increasing it ( I kid only slightly)

 

[Dr Oops]

And I will reiterate that even begin to associate physician compensation to the absurdly low teacher pay is insulting to teachers. My wife stood before her OBGYN complaining about why I wanted to go to medical school when their compensation was steadily going down. She replied "well I don't think it's quite 35k." Her OBGYN felt like an ass. Rightfully so. Even as good of a doctor as she is. It's important to keep things in perspective.

Compensation isn't about money, it's about 11 years of investment before we're allowed to talk to a patient without someone signing off on us. Saying you aren't going into medicine for the money is like a teacher saying they don't care about the summers. Sure, it isn't the only thing, but it's a nice perk.

how is that rightfully so? Your wife makes a useful contribution to society but does she didnt spend 11 years training to do so. NO ONE is gonna jump through all the hoops required to become a dr for 35K, thats why it will never happen. Your wife may have worked hard to become a teacher, but its no where near the bs you need to do to be a physician.

Theres nothing wrong with trying to protect your hard earned money. Even the teachers do it, gasp! You really gonna jump down someone throat because theyre not happy that someone else is taking their money? Let me apologize on behalf of those people for being human. I wish we could all be as awesome as you.

I think you need to get some perspective. Doctors work just as hard as everyone else. They deserve to be paid accordingly. Yea we need healthcare reform. We also need to look out for physicians interests because ABSOLUTELY NO ONE else will. If you dont think this helps patients either youre wrong, just look at the Primary care situation. Its the lowest paying specialty, students are scared of the ever increasing debt and as a result we dont produce enough pcps.

 

[medapplicant88]

This is an interesting debate. I think the healthcare reform is still up in limbo. The republicans will try and block it at every point of implementation.

I'm so confused about reform. To me reform is about cutting healthcare costs. But not many of the experts on the news say that this bill is going to help with that.

 

[JeetKuneDo]

From reading Tekar's posts, you believe doctors should be compensated the same as now or higher, yes? Just trying to sort things out, I'll admit I'm a little confused with the wording used in some of the posts.

 

[StayOnTop]

Doctors will make more, of course they will. The question is, will the rate of salary increase stay the same, go higher, or go lower? I say go lower, and the amount of work doctors will have to do will increase, especially if docs continue to avoid going into primary care.

I mean, starting this month, 100K baby boomers will retire everyday for the next 20 years. Someone has to take care of them.

Some clarifications, though. Medicaid reimbursement will actually be brought up, I believe, to match medicare rates, and the cuts in Medicare reimbursement to doctors has been delayed again.

 

[Parts Unknown]

Eventually the Healthcare reform will cause more doctors to earn less especially in primary care. There are hidden things in the bill that make it this way. 1) Residents will now have to pay federal taxes, and withholdings. 2) Less $$$ is available by government loans due to the student loan reform section of the healthcare reform bill (less money allowed to be loaned plus higher interest rates = a lot more money to pay back) 3) less funding for residencies 4) Insurance companies can deny a lot more to make up for their losses, making care worse for your patients and causing you to loose money by not performing procedures. 5) 80% has to go to care, but that is not defined, there are already loopholes that were found and announced and the system will continue at status quo. 6) more denied procedure thanks to insurance companies leads to unhappy patients = more lawsuits, less appointments more court costs and less earnings

With regard to 1, residents already pay federal taxes.

With regards to the rest, here is a link to the full text of HR 3590. Please identify the sections that substantiate points 2-4 and 5.

Thanks.

 

[NYEMMED]

With regard to 1, residents already pay federal taxes.

With regards to the rest, here is a link to the full text of HR 3590. Please identify the sections that substantiate points 2-4 and 5.

Thanks.

Well 1) Residents never had to pay towards FICA, which was now reversed in the bill, and a supreme court challenge was overruled so starting very soon all residents must pay, I believe the 12% of earnings towards FICA 2) As a current student, once the government took over the student loans with the Healthcare bill, the amount we are now allowed to take out is $6,000-8,000 less than last year, And our interest rate has also gone up quite a bit from last year. Ask any medical school Financial aid officer and they will back that up. 3) What funds Residencies? Medicare/Medicaid? That was cut in the bill, where did the govt find an easy temporary fix? Taking some of that amount out of the budget alloted towards residencies. 4) Where does it say anywhere in the bill that insurance companies are being regulated? They can deny whatever they want and will, to make up costs. The only exception is the pre-existing conditions clause, which was an awesome change. Other than that this reform gave insurance companies what they wanted, Everyone must buy from them, and no regulation or oversight of their practices. 5) this is right in the bill 80% of an insurance companies income must go towards patient care. These companies also very quickly how to get around that... Im not against HC reform, I really think this was a pretty shoddy job though... In the end I believe we need something regulating and creating oversight on the insurance companies, These companies make healthcare hard, and as an attending im sure you know about the red tape and the run around trying to get things approved for patients.

 

[Parts Unknown]

Well 1) Residents never had to pay towards FICA, which was now reversed in the bill, and a supreme court challenge was overruled so starting very soon all residents must pay, I believe the 12% of earnings towards FICA

Hmmm, I was a resident and paid FICA long before this bill ever came along. This is an issue with a rather long history, and I don't believe HR 3590 says anything about it. Correct me if I am wrong.

2) As a current student, once the government took over the student loans with the Healthcare bill, the amount we are now allowed to take out is $6,000-8,000 less than last year, And our interest rate has also gone up quite a bit from last year. Ask any medical school Financial aid officer and they will back that up.

Took over? The private student loans were almost all backed by government dollars. Uncle Sam simply quit paying the middle man.

The Direct Loan terms I see are $20,500 ($8,500) per year at 6.8%. I don't think they have changed. Again, correct me if I am wrong.

What funds Residencies? Medicare/Medicaid? That was cut in the bill, where did the govt find an easy temporary fix? Taking some of that amount out of the budget alloted towards residencies.

Yes, residency programs are funded through CMS, but most of the prescribed Medicare cuts are coming from Advantage, which has nothing to do with training funding.

If there is a prescribed cut in training funding, please reference it.

this is right in the bill 80% of an insurance companies income must go towards patient care.

Actually the medical loss ratio for most situations will be 85%. Only small insurers will have 80%.

These companies also very quickly how to get around that...

Perhaps, but you may be please to read this.

 

[FutureCTDoc]

Physicians are likely to get a smaller piece of a similar sized pie. The government is basically broke and it's a matter of time before real entitlement cuts are going to happen. The biggest threat facing physicians is going to be not directly from the healthcare bill, but rather from the fact that there will likely be substantive medicare cuts at some point.

 

[scpod]

The only group of physicians that have a hope of making more money from this legislation are the primary care providers by making everyone buy insurance. If everyone has insurance, that means everyone is able to see a doctor before they run to the ER.....

Not really true at all. Look at what happened in Massachusetts. They started a program of Universal Care and everyone got insurance. But, it ended up increasing the number of ER visits by 7% and increased the cost of ER care by 17%. In real life, a lot of people just will not go to a primary care doctor. They will wait until the last minute, then go to the ER.

You give them insurance and they will still not go to a primary care doc. I have a multitude of patients that I admit every day and treat in the hospital. They don't have a primary care doc. I schedule appointments with them to see me at the community clinic where it only costs 5 bucks if you have no money. They still don't follow up after their discharge.

Giving people insurance is NOT the way to change healthcare in this country. Decreasing the cost of healthcare might help. If so many people are going to the ER for healthcare then you have to find a way to make it cheaper. The best way to do that is to get rid of the fear of lawsuits. Make malpractice reform a priority.

Do you know what happens to everyone who comes into my hospital's ER with chest pain? Even if the docs are 1000% sure it's not an MI they still get a full cardiac workup and usually a CT to rule out a PE too. It costs gazillions of dollars to go to the ER because the docs are afraid of that 1 in a million case where they actually miss something and get sued for it. AND, malpractice reform is not on the radar of either party. It just wont happen as long as lawyers control congress.

 

[pdeco1]

The only group of physicians that have a hope of making more money from this legislation are the primary care providers by making everyone buy insurance. If everyone has insurance, that means everyone is able to see a doctor before they run to the ER. Plus, it's causing lots of babyboomer docs to run for the hills creating a new type of shortage...physician exodus. Good riddance. Lemme leave you a box of cards to hand to your patients before you hang the closed sign.

The 80% thing is complete and total garbage. Take an accounting class to learn how ridiculous the concept of mandated spending is to those trying to milk more money out of insurance. All they will do is recategorize transactions they didn't count but were doing anyway into some form of a "patient care" category.

News flash people, nothing is going to change. You're still going to continue getting screwed by insurance companies who pay millions of dollars to make you think it's the government screwing you. It's not. It's the billionaires who want to be bigger billionaires. Medicare pays it's top executive 175k. CIGNA paid their top executive 24 million. You do the math.

Your my hero. I love it how the billionaires constantly remind us not to trust the government while they constantly steal from the taxpayer. The housing crisis: Government and middle class go broke, wealthiest 1% get richer! Government option for healthcare? Nope, shot down by the health insurance industry so they can keep all the profits. How do people not see this? Now the top 1% has gone after doctors.

 

[MLT2MT2DO]

The best way to do that is to get rid of the fear of lawsuits. Make malpractice reform a priority.

Do you know what happens to everyone who comes into my hospital's ER with chest pain? Even if the docs are 1000% sure it's not an MI they still get a full cardiac workup and usually a CT to rule out a PE too. It costs gazillions of dollars to go to the ER because the docs are afraid of that 1 in a million case where they actually miss something and get sued for it. AND, malpractice reform is not on the radar of either party. It just wont happen as long as lawyers control congress.

I usually don't bother posting on political threads here but this is exactly what I believe is a HUGE issue. I work in a clinical lab and we see tons of Troponin's ordered on kids younger than 24 years of age who just got done running two miles and came in with tightness in their chest (because the last time they ran 2 miles was 2+ years ago), yet these cardiac panels get ordered because of malpractice. We even have one doc that will do serial (check 3x) shortness of breath screens and all must be negative before discharge. I don't think our ER doctors are dumb, I think they are scared of malpractice.

I think alot of cutting healthcare costs in our country will require Emergency Rooms to become Emergency Rooms once again. So much needs to be put back on the patient. But the general public doesn't want to hear that.

 

[VeeTeeHokies]

The only group of physicians that have a hope of making more money from this legislation are the primary care providers by making everyone buy insurance. If everyone has insurance, that means everyone is able to see a doctor before they run to the ER. Plus, it's causing lots of babyboomer docs to run for the hills creating a new type of shortage...physician exodus. Good riddance. Lemme leave you a box of cards to hand to your patients before you hang the closed sign.

The 80% thing is complete and total garbage. Take an accounting class to learn how ridiculous the concept of mandated spending is to those trying to milk more money out of insurance. All they will do is recategorize transactions they didn't count but were doing anyway into some form of a "patient care" category.

News flash people, nothing is going to change. You're still going to continue getting screwed by insurance companies who pay millions of dollars to make you think it's the government screwing you. It's not. It's the billionaires who want to be bigger billionaires. Medicare pays it's top executive 175k. CIGNA paid their top executive 24 million. You do the math.

I agree 100% with paragraphs 2 and 3 of this, however paragraph 1 not so much...

We still have no idea what kind of reimbursements we're looking at through these government insurance kiosks that are supposed to be popping up around 2014 and I'd be willing to wager that they're very similar to medicare and medicaid. Physicians aren't running to the hills because the hills are the rural areas that already have no PC docs and these are also the areas with some of the highest per capita elderly population. With no docs there, patients are just having to purchase something that they aren't able to use in insurance. And this is going to lead to even longer lines at the ERs, but in all likelihood with Medicare-esque reimbursement.

The main point is that we don't have a primary care infrastructure to support this bill, and unfortunately we're all going to have to suffer through the learning curve of congress and businessmen/women who have no health care experience to figure out.

 

[VeeTeeHokies]

Not really true at all. Look at what happened in Massachusetts. They started a program of Universal Care and everyone got insurance. But, it ended up increasing the number of ER visits by 7% and increased the cost of ER care by 17%. In real life, a lot of people just will not go to a primary care doctor. They will wait until the last minute, then go to the ER.

You give them insurance and they will still not go to a primary care doc. I have a multitude of patients that I admit every day and treat in the hospital. They don't have a primary care doc. I schedule appointments with them to see me at the community clinic where it only costs 5 bucks if you have no money. They still don't follow up after their discharge.

Giving people insurance is NOT the way to change healthcare in this country. Decreasing the cost of healthcare might help. If so many people are going to the ER for healthcare then you have to find a way to make it cheaper. The best way to do that is to get rid of the fear of lawsuits. Make malpractice reform a priority.

Do you know what happens to everyone who comes into my hospital's ER with chest pain? Even if the docs are 1000% sure it's not an MI they still get a full cardiac workup and usually a CT to rule out a PE too. It costs gazillions of dollars to go to the ER because the docs are afraid of that 1 in a million case where they actually miss something and get sued for it. AND, malpractice reform is not on the radar of either party. It just wont happen as long as lawyers control congress.

Wish I would have read further down before I posted a reply to Tekar. You summed it up perfectly. When I was working in the ER we would get innumerable patients who had chest pain for a month and all of a sudden decide to come to the ER at 3 AM on a Wednesday night when it became "unbearable." And these are insured individuals in an area where there is abundant primary care and urgent care. Most, if not all, of these patients also had their own primary care doc that they completely neglected in these situations.

 

[moca83]

Your my hero. I love it how the billionaires constantly remind us not to trust the government while they constantly steal from the taxpayer. The housing crisis: Government and middle class go broke, wealthiest 1% get richer! Government option for healthcare? Nope, shot down by the health insurance industry so they can keep all the profits. How do people not see this? Now the top 1% has gone after doctors.

Believe me, I'm as against the ever-increasing wealth disparity as anyone, but with all due respect, are you sure you understand the distinction between insurance companies, per se, and the executives who run them? If you look at the margins (I.e., gross/net profit margins) of insurance companies, you will notice a striking fact...their margins are very low, only around 3% or so for NPM. The healthcare insurance industry model just so happens to be an efficient and profitable one, especially since it's tied to health risks. The real problem is in how executives are compensated, a whole different issue all together. Also, it shouldn't come as any surprise that when government steps in to address social/economic issues, taxes are usually involved and people's standard of living (as measured by GDP) is inversely related to taxes.

 

[JaggerPlate]

I was 100% pro-tort reform until I heard something the other day that made me think ...

A resident in one of the numerous NP/DNP threads was discussing how if they really enacted an across the board tort reform, it would take a lot of pressure off one of the last barriers keeping the mid-levels from truly practicing independently - the fear of BIG lawsuits because they are practicing medicine without the knowledge/experience of medical school and residency. If universal tort reform and caps went into place, it makes me wonder if it wouldn't create another frustrating tip toward more DNP/NP independence, which I always view as a complete negative.

I haven't personally thought too much about it yet, but just an interesting perspective, especially coming from a resident. Thoughts?

 

[pdeco1]

Believe me, I'm as against the ever-increasing wealth disparity as anyone, but with all due respect, are you sure you understand the distinction between insurance companies, per se, and the executives who run them? If you look at the margins (I.e., gross/net profit margins) of insurance companies, you will notice a striking fact...their margins are very low, only around 3% or so for NPM. The healthcare insurance industry model just so happens to be an efficient and profitable one, especially since it's tied to health risks. The real problem is in how executives are compensated, a whole different issue all together. Also, it shouldn't come as any surprise that when government steps in to address social/economic issues, taxes are usually involved and people's standard of living (as measured by GDP) is inversely related to taxes.

The "for profit at all cost" model is the problem. When you cannot legally turn away anyone, combined with the for profit model you are inherently creating losers. Who is going to lose? Health care workers. The insurance, device and drug companies are too strong to take a hit. But the nurses and doctors are not and it seems doctors are the easiest to blame. There is an increasing backlash against doctors pay fueled by the corporate owned media. The message is that its justifiable for the executives and other extremely wealthy to amass ridiculous amounts of money while the actual doctor saving your life should be paid less.

The ideal setting would be a fair wage non profit system where profits are cycled back into the system. Providers are rewarded for reaching benchmarks in efficiency and consumers are rewarded by sustaining a range of health related benchmarks. Is it that simple, no. There are a ton of far more intelligent individuals who know more but our government is run by corporate interests and it permeates both sides of the isle. This means the masses are under siege by the wealthy. Its no coincidence that wealth disparities are higher now than ever before in our country's history. The wealthy 1% have taken over and its exploded since the 1980s. They become wealthy off of the lower classes and through lobbying have slashed tax rates. Many people of the lower classes believe this to be fair because they one day think they will be a part of the elite or have other dellussions.

"As of 2007, the top decile of American earners, Saez writes, pulled in 49.7 percent of total wages, a level that's "higher than any other year since 1917 and even surpasses 1928, the peak of stock market bubble in the 'roaring" 1920s.'"

http://www.huffingtonpost.com/2009/08/14/income-inequality-is-at-a_n_259516.html

Happy Thursday SDN!

 

[scpod]

....If universal tort reform and caps went into place, it makes me wonder if it wouldn't create another frustrating tip toward more DNP/NP independence, which I always view as a complete negative....

I don't see it that way. I'll give you an example. A patient is tranferred to my hospital for admission from a smaller facility. She began having a rash and fevers quite a while back. She couldn't get into see her PCP because he was busy, so she saw his PA. He gave her some antibiotics and prednisone. She didn't get better and kept coming back with more symptoms. He did some tests and found her ANA was positive and she was throbocytopenic so referred her to a Rheumatologist. She couldn't get in for months. Finally, she got so bad that she went to a local ER and was tranferred to us because they don't have specialists there. Shortly thereafter we diagnose her with peripheral t-cell lymphoma and she doesn't have a very good prognosis.

What happens if the family decides to sue? They go after the MD because he has the insurance money-- not the PA. No matter what happens this MD has to sign off on the PAs charts and is ultimately responsible. Does that change because you institute tort reform? I just don't see it. They still sue the doc, they just don't get as much. Maybe next time, the doc will probably look a little more closely at those charts.

The way we practice medicine is based on codes and arbitray payment rules. It pays the hospital more to diagnose a a patient with "sepsis secondary to uti" than "urospesis". It's semantics, but I have to make sure I write it the correct way. If I phrase my ROS wrong in an H&P or don't put in enough systems we get paid $180 less. I need to make sure that I have at least 5 organ systems each with two findings in my daily progress notes or Medicare will nock us down a level in reimbursement. A big part of my day is spent reading these little notes in the chart by some coder who asks if I can add a diagnosis of "morbid obesity" because they calculated the patient's BMI at 40.1, or can you add ABLA to the diagnoses since the hemocult was positive and H&H low. The hospital will get paid more if I can add that in. Most of the things I do during the day are not done for medical reasons, it's all a big billing thing. There is no such thing as "non-profit" in medicine because everything you do is done for the money.

Medicine is ultimately broken because we don't practice medicine... we practice billing and coding. Tort reform would just take off a lot of the pressure and enable us to save a lot of dollars in expensive tests that we don't really need anyway.