More CMG turmoil- Envision CEO stepping down

[GeneralVeers]

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Once you're dead and your bottom line was not affected, you would not rather the country try changing to another corrupt system that has some tiny possibility of accountability? Apparently the current system is destroying EM anyway via corruption/greed.

No. I want a complete free market healthcare system with up-front pricing and cost controls at the consumer level. The Federal government should be out of healthcare entirely. If individual states want to tinker with socialized medicine, then so be it. Unfortunately our Federal politicians view this as an unlimited grab-bag for their own power and self-enrichment so want to bring this nonsense to us on a national level.

 

[deleted480308]

You mean socialism... like EMTALA and the rules against pre-existing conditions? I've always found it funny how "conservatives" claim they don't want socialism, but love social security, medicare, medicaid, EMTALA, and the free stuff parts of the Affordable Care Act.

Cancel it all

 

[GeneralVeers]

Cancel it all

#cancelculture

 

[RustedFox]

Seriously.

My expertise and labor is no different than that of the mechanic, the plumber, or the roofer.
They do not work for "free", or at fixed rates designated by a beauraucrat that knows nothing of my/their work.

The nobility of our work does not supersede the fact that it is work.

 

[Siggy]

Seriously.

My expertise and labor is no different than that of the mechanic, the plumber, or the roofer.
They do not work for "free", or at fixed rates designated by a beauraucrat that knows nothing of my/their work.

The nobility of our work does not supersede the fact that it is work.

I've yet to have a mechanic not tell me the cost of the work prior to the work being completed. Can you post your prices specifically? How about the prices of the work you are recommending the patient has done?

I agree that the nobility of the work doesn't supersede the fact that it's work. However it's simplistic to say that medicine is the same as a mechanic... because the payment situation (and ramification of not getting the work done) is drastically different.

I've also seen a lot of posts here poo-pooing insurance companies. There's nothing stopping you from billing patients directly and letting them fight with their insurance company (I mean... sure, and a lot of them won't pay... but that's a different situation) or you've entered into a contract with an insurance company... which means that what they reimburse you is acceptable (as with any contract).

There's also poo-pooing of EMTALA, which I agree is a contributing factor, but I also bet that holy hell would be raised if a family member entered the medical system as a John Doe with an uncertain insurance status and care was refused. If you aren't prepared to refuse care to someone based on their ability to pay, then the comparison to mechanics and roofers falls flat. I haven't met a mechanic willing to repair a car for free.

 

[ShockIndex]

I've yet to have a mechanic not tell me the cost of the work prior to the work being completed.

Just say’n...

 

[GeneralVeers]

I'd be happy to post my fee schedule and price-list for self pay patients up front. Unfortunately the meddling government refuses to let me do so due to EMTALA.

 

[bravotwozero]

You can post your fee schedule after doing a medical screening exam. That is not an EMTALA violation. Whether hospital admin or your CMG will allow you to do that is a different matter...


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[VA Hopeful Dr]

I'd be happy to post my fee schedule and price-list for self pay patients up front. Unfortunately the meddling government refuses to let me do so due to EMTALA.

And this is actually becoming more and more common outside of hospital systems: direct primary care, cash-only surgery centers, and a fair number of private practices in general.

Now this couldn't work for everything: some things are expensive enough that the cash prices are outside the reach of 99.9% of people - prolonged ICU stays, BMT, trauma. But lots of things are surprisingly inexpensive.

 

[deleted941485]

And this is actually becoming more and more common outside of hospital systems: direct primary care, cash-only surgery centers, and a fair number of private practices in general.

Now this couldn't work for everything: some things are expensive enough that the cash prices are outside the reach of 99.9% of people - prolonged ICU stays, BMT, trauma. But lots of things are surprisingly inexpensive.

Which is what insurance should have been for all along. Those sudden expensive medical events. I know I’ll cagch a lot of
Flaky but your PCP appts shouldn’t be a part of it...and yet here we are.

 

[bronx43]

Seriously.

My expertise and labor is no different than that of the mechanic, the plumber, or the roofer.
They do not work for "free", or at fixed rates designated by a beauraucrat that knows nothing of my/their work.

The nobility of our work does not supersede the fact that it is work.

Why don't you go start up your own ED and post your prices? Or maybe your own urgent care.

 

[RustedFox]

Why don't you go start up your own ED and post your prices? Or maybe your own urgent care.

One urgent care nearby has done just that.
Asking me to run a business would be like trying to teach calculus to a donkey.

 

[GeneralVeers]

Why don't you go start up your own ED and post your prices? Or maybe your own urgent care.

It's only possible for cash-pay patients. Every patient with insurance will have a different deductible and co-pay.

 

[GeneralVeers]

You can post your fee schedule after doing a medical screening exam. That is not an EMTALA violation. Whether hospital admin or your CMG will allow you to do that is a different matter...


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Correct, but most hospitals refuse to allow the medical screening exam weed-out due to greed. It should be mandatory for Medicaid/Medicare patients to have an MSE then be forced to pay a co-pay up front if determined to not be an emergency. I have a suspicion though, that every hospital/CMG would convince us to label almost every visit as an "emergency" in order to get paid.

 

[EctopicFetus]

Why don't you go start up your own ED and post your prices? Or maybe your own urgent care.

Govt wont let me. I would do this in a heartbeat. Look at texas.. FSED sprung up like crazy. Thinking this would not empower docs is stupid. We would turn the system on its head.

 

[deleted941485]

Idk when M4A gets passed theyll be a nationwide CON probably required to
Open one and guess who won’t be determining the prices.

 

[Dr Mantis Toboggan]

Trying to open your urgent care and get Blue Cross to allow to be you in network is not easy.

Why don't you go start up your own ED and post your prices? Or maybe your own urgent care.

 

[bronx43]

Govt wont let me. I would do this in a heartbeat. Look at texas.. FSED sprung up like crazy. Thinking this would not empower docs is stupid. We would turn the system on its head.

Free standing EDs are not what you are describing. They simply pluck off the high reimbursing privately insured patients. Even the upper middle class wouldn’t spend that kind of out of pocket cash unless they were dying.

I think you are looking at this from rose colored glasses. I am in a physician owned multispecialty group. If I wanted, I can go to a cash only model tomorrow. Even though I’m the only physician of my specialty within 8 counties, I’m not sure I can keep the lights on. There may be a niche market for concierge medicine but most specialties can’t do this. From what I see in the market, there is a good amount of elasticity in healthcare demand when people have to pay out of pocket.

 

[bronx43]

Trying to open your urgent care and get Blue Cross to allow to be you in network is not easy.

I was responding to the idea that you go cash based

 

[Dr Mantis Toboggan]

Oh yeah. That can be a part of a successful UC, but not enough to be sustainable from what I’ve seen. Just not enough patients who are willing to pay out of pocket, at least around here.

I was responding to the idea that you go cash based

 

[VA Hopeful Dr]

Oh yeah. That can be a part of a successful UC, but not enough to be sustainable from what I’ve seen. Just not enough patients who are willing to pay out of pocket, at least around here.

You'd be surprised

 

[Dr Mantis Toboggan]

10% of the one I’ve got a piece of. Nothing to sneeze at.

You'd be surprised

 

[bronx43]

10% of the one I’ve got a piece of. Nothing to sneeze at.

Do they pay significantly more out of pocket than what is reimbursed by insurers?

 

[VA Hopeful Dr]

10% of the one I’ve got a piece of. Nothing to sneeze at.

There's your mistake - you have an insurance based UC that happens to see cash pay patients.

If you plan to be 100% cash pay from the start, you do things differently.

 

[Dr Mantis Toboggan]

Fair enough.

There's your mistake - you have an insurance based UC that happens to see cash pay patients.

If you plan to be 100% cash pay from the start, you do things differently.

 

[Dr Mantis Toboggan]

Nah between the copay and insurance reimbursement it’s similar.

Do they pay significantly more out of pocket than what is reimbursed by insurers?

 

[bronx43]

There's your mistake - you have an insurance based UC that happens to see cash pay patients.

If you plan to be 100% cash pay from the start, you do things differently.

Agreed. Your prices would have to be low enough, which you may be able to provide if you get rid of overhead for coding/billing.

 

[VA Hopeful Dr]

Agreed. Your prices would have to be low enough, which you may be able to provide if you get rid of overhead for coding/billing.

Exactly that. Cash only primary care (and urgent care would be almost identical) has overhead of around 30%.

So let's say you want to earn $125/hr. You'd need to bring in roughly $180/hr to make that happen. If you charge $70 for a visit, that's only 2.5 patients/hour. By urgent care standards that's barely working at all.

 

[GeneralVeers]

Exactly that. Cash only primary care (and urgent care would be almost identical) has overhead of around 30%.

So let's say you want to earn $125/hr. You'd need to bring in roughly $180/hr to make that happen. If you charge $70 for a visit, that's only 2.5 patients/hour. By urgent care standards that's barely working at all.

Also if you are doing cash pay and not worried about insurers, your documentation could be minimal at that point.

 

[VA Hopeful Dr]

Also if you are doing cash pay and not worried about insurers, your documentation could be minimal at that point.

Yep. Here's a note I wrote a few years ago on a patient who came in to my cash-only practice one day:

S: Pt with 2d h/o left eye green discharge, mildly irritated, no blurry vision or pain.

O: Eye: PERRL, EOMI, left conjunctiva with erythema and watery discharge

A/P:
1. Conjunctivitis - likely viral, acular for symptoms

 

[BoardingDoc]

Yep. Here's a note I wrote a few years ago on a patient who came in to my cash-only practice one day:

S: Pt with 2d h/o left eye green discharge, mildly irritated, no blurry vision or pain.

O: Eye: PERRL, EOMI, left conjunctiva with erythema and watery discharge

A/P:
1. Conjunctivitis - likely viral, acular for symptoms

This was useful if for no other reason than to introduce me to acular. Never heard of it. When I see people in UC with clear viral conjunctivitis, I usually give them opcon (basically visine and an antihistamine). The acular idea is interesting.

 

[deleted547339]

Wrong. Conservatives and Liberals both don't care about the deficit. There is zero appetite in either party to control the growth of entitlements which is mostly to blame for the deficit. Both establishments are corrupt officials who've reached a bargain whereby they have slight policy differences around the edges, but agree to keep feeding the "blob" which is the massive lobbyist/administrative state that doles out billions of tax dollars to corrupt former Republican and Democrat office-holders.

The reason Democrats want Single Payer, is not because it will "help" people or that they are kind, generous politicians. They want this terrible policy because it is a way to massively expand their power, and use it to take $trillions from the private economy to fund their corrupt ecosystem.

Proles is, I think, the word you’re looking for.

 

[alpinism]

Its the same with emergency medicine in other countries.

Cash pay and minimal documentation requirements.

Here's an example of a note for South Africans.

ED Management
Stab wound to chest with likely tension pneumothorax
Administered 100% NRB oxygen and IV fluid bolus
US confimed right sided tension pneumothorax
Chest tube placed with no complications
CXR showed good lung expansion
Admitted to medicine

 

[NYEMMED]

Its the same with emergency medicine in other countries.

Cash pay and minimal documentation requirements.

Here's an example of a note for South Africans.

ED Management
Stab wound to chest with likely tension pneumothorax
Administered 100% NRB oxygen and IV fluid bolus
US confimed right sided tension pneumothorax
Chest tube placed with no complications
CXR showed good lung expansion
Admitted to medicine

When you don’t need to worry about lawsuits, that is all that is needed.

we chart the amount we do here for lawyers, and insurance/government

 

[EctopicFetus]

Free standing EDs are not what you are describing. They simply pluck off the high reimbursing privately insured patients. Even the upper middle class wouldn’t spend that kind of out of pocket cash unless they were dying.

I think you are looking at this from rose colored glasses. I am in a physician owned multispecialty group. If I wanted, I can go to a cash only model tomorrow. Even though I’m the only physician of my specialty within 8 counties, I’m not sure I can keep the lights on. There may be a niche market for concierge medicine but most specialties can’t do this. From what I see in the market, there is a good amount of elasticity in healthcare demand when people have to pay out of pocket.

being a FSED doesnt mean you arent in network. it does mean you arent beholden to a hospital and their BS. Ill admit I am not an owner is a FSED. but i know people who are. I think people on here are.. overall, they like the control, the lower volumes and decent pay. I would bet the timeliness of care and quality is better. Who wouldnt want to make good money seeing a normal volume of patients.

Also yes, the set up to take care of people with money. Just like an ASC, just like an ophtho office. I get EMTALA and i like it. I also realize we see a ton of nonsense. We are shat upon by CMGs and hospitals. You know why? Cause they can. we have no option. Why does ortho get treated so well casuse they can take their business elsewhere, other hospitals, ASCs, their clinics etc.

 

[deleted109597]

Free standing EDs are not what you are describing. They simply pluck off the high reimbursing privately insured patients. Even the upper middle class wouldn’t spend that kind of out of pocket cash unless they were dying.

Said by someone who clearly gets only one side of the story.
FSEDs are required by Texas to meet EMTALA standards, even though they can't bill CMS. Medicare/Medicaid pt shows up? They get MSE'd. If they're having a stroke or heart attack? Well then you're screwed.
And yet, insurance companies still refusing to pay even though they're required by law under prudent layperson (which only applies to non-ERISA plans). So you're getting cut from both sides.

Sure, FSEDs make their money on the non-emergencies, but here's the thing. So do hospitals. Do you think that if they made an "emergency standard" that required an actual life threat to get paid, that any pediatric ED would be open tomorrow? Do you think your hospital doesn't bill emergency levels for fast track patients?

 

[bronx43]

Said by someone who clearly gets only one side of the story.
FSEDs are required by Texas to meet EMTALA standards, even though they can't bill CMS. Medicare/Medicaid pt shows up? They get MSE'd. If they're having a stroke or heart attack? Well then you're screwed.
And yet, insurance companies still refusing to pay even though they're required by law under prudent layperson (which only applies to non-ERISA plans). So you're getting cut from both sides.

Sure, FSEDs make their money on the non-emergencies, but here's the thing. So do hospitals. Do you think that if they made an "emergency standard" that required an actual life threat to get paid, that any pediatric ED would be open tomorrow? Do you think your hospital doesn't bill emergency levels for fast track patients?

Huh? I was referring mainly to the self pay component of the discussion - not that FSEDs don’t adhere to Emtala. But thanks for all that...

 

[deleted109597]

Huh? I was referring mainly to the self pay component of the discussion - not that FSEDs don’t adhere to Emtala. But thanks for all that...

And you're still wrong. Plenty of FSED patients self pay. Most private FEC have self-pay charges that top out around 2500-3000 for the visit, which can be way less than a patient's copay plus coinsurance plus deductible might run at a normal place. That includes, labs, CT, IV meds, you name it.



But yes, the bottom of the barrel completely unfunded patients will generally go wherever they can go. They typically either use EMS once they get incredibly sick, or give false names when they're less sick. Hospitals should probably MSE the less sick ones out too.

 

[bronx43]

And you're still wrong. Plenty of FSED patients self pay. Most private FEC have self-pay charges that top out around 2500-3000 for the visit, which can be way less than a patient's copay plus coinsurance plus deductible might run at a normal place. That includes, labs, CT, IV meds, you name it.



But yes, the bottom of the barrel completely unfunded patients will generally go wherever they can go. They typically either use EMS once they get incredibly sick, or give false names when they're less sick. Hospitals should probably MSE the less sick ones out too.

What percent of them pay out of pocket?

 

[deleted109597]

What percent of them pay out of pocket?

Around 20% are self pay. Of that, probably 10% (half of the self pay) actually pay up.
Of course, that's at the shop I ran. I don't have numbers for the whole state.