Not breaking news, but it's still interesting!

[soonerfrog]

http://www.npr.org/2013/08/07/20958...merican-health-care-is-so-pricey?sc=17&f=1128

On many levels, it's hard to wrap your head around a 1000% price difference...airfare included.

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[chocomorsel]

http://www.npr.org/2013/08/07/20958...merican-health-care-is-so-pricey?sc=17&f=1128

On many levels, it's hard to wrap your head around a 1000% price difference...airfare included.

Welcome to America baby!!!! Land of the free, the brave, apple pie and motherhood as my old professor used to say.

Anyway, in most other countries, people are taxed close to 50% of their income and physicians do not make half of what they make here.

Take a poll and see how many of us would be fine, with making less money and getting taxed more in order for everyone to have access to "free" healthcare.

Capitalism at it's best. Terrible though as we should have universal healthcare. It would cost a helluva lot less.

Have thought of moving to Canada to see what it's like to practice real medicine and not worry much about malpractice. But I have four years of training and hate the cold weather, so not happening. But I don't plan on living here forever though.

 

[BLADEMDA]

Medicare pays about $16,000 for a total hip replacement. Add the surgeon fee and anesthesia and the total is still under 18K.

$100,000 for a total hip? No way.

 

[BLADEMDA]

Patients 'shocked' by low Medicare reimbursements

Aging orthopedic patients fear access to surgery could be in jeopardy
June 13, 2012 | By Debra Beaulieu
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Physicians often feel that Medicare reimbursements are too low for the amount of work they perform, and a new study suggests that patients not only agree, but they worry about low Medicare rates threatening their access to needed care. For the study, published in the Journal of Arthoplasty, researchers asked orthopedic patients to estimate what they thought surgeons should be paid for total hip arthroplasty (THA) and total knee arthroplasty (TKA), as well as what they thought Medicare actually reimbursed doctors for the procedures.

According to the study, patients thought that surgeons should receive $18,501 for total hip replacements and $16,822 for total knee replacements but estimated that were paid $11,151 and $8,902, respectively. Even with patients' estimates being at least six times lower than actual reimbursement rates for THA and TKA--$1,378 and $1,430--70 percent of patients stated that Medicare reimbursement was "much lower" than what it should be.

Patients who had higher education levels, had received one of the procedures, or belonged to an HMO or PPO tended to perceive the value of both THA and TKA as being higher, but the researchers were surprised by how significantly inaccurate the estimates were. In an email to Freakonomics, orthopedic surgeon and study coauthor Jared Foran wrote, "In short, patients--the most important part of all of healthcare policy decisions--have absolutely no clue how much doctors get paid. They think we get paid (or, at least, deserve to) about 10 times more than we actually do!"


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Study participants also found the real numbers eye-opening, with comments such as the following occurring repeatedly: "I am shocked," "I am ashamed," "this is unfair." One patient commented, "It's amazing doctors are even willing to take Medicare." Yet another stated, "I feel it is an insult to pay a doctors with this much knowledge a little more than $1,000 to perform surgery … If we don't start paying our doctors what they are worth, there aren't going to be doctors when we need surgery."

To learn more:
- see the post from Freakonomics
- read the study from the Journal of Arthoplasty (.pdf)

Related Articles:
Hospitals, docs unsatisfied with Affordable Care Act
Hard times for doctors mean less access for poor
Former CMS chiefs want SGR repeal

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Read more: Patients 'shocked' by low Medicare reimbursements - FiercePracticeManagement http://www.fiercepracticemanagement...icare-reimbursements/2012-06-13#ixzz2bWndl4zp
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[BLADEMDA]

http://www.nebh.org/media/100330/Top_25_Hip_Surgery.pdf

Take a look.

 

[BLADEMDA]

How Much Does Hip Surgery Cost? A Medicare Patient's Experience.


My father recently broke his hip and had a one week stay at Banner Thunderbird hospital in Phoenix, AZ. I recently wrote about that experience from my perspective. As promised, I will show you the economics of that hospital stay. As you may or may not be aware, most large hospitals get paid by the Medicare National Bank using algorithms that define the economic value of more than 700 diagnosis related groups (DRGs). The payments are based on these DRG principle diagnoses with add on complicating conditions (CC) and major complicating conditions (MCC). A hip fracture admission gets paid a different amount than a pneumonia admission. A pneumonia admission gets paid a different amount than a stroke admission. Whether the patient was in the hospital for two days or two weeks doesn't matter. The payment would be the same. However, a hip fracture complicated by a CC or an MCC may get paid more than a hip fracture without any complicating conditions. This is why length of stay is important in hospital economics.

You can see how transparency in hospital economics can become quite difficult quite quickly. It's hard to tell a patient what the cash price for a hip fracture surgery will be when the cost of care is only known after the fact. In fact, even Medicare can't tell a hospital how much they are going to make until the patient is discharged because the price is dependent on the preexisting complicating conditions and the hundreds of potentially complicating conditions that may or may not arise during the hospital stay.

This is why clinical documentation nurse specialists and hospitalists, working in collaboration, have become necessary for hospitals to survive the negative Medicare margins they now enjoy with a smile. Clinical nurse specialists have been hired by hospitals all across the country to scour patient charts, in real time, and to find those CC and MCCs that provide additional payment for DRGs so physicians can document them in the chart.

Did you know if your hospitalist fails to document "morbid obesity" on an 800 pound patient or forgets to write "severe protein malnutrition" on a patient with a documented albumin of 1.5, hospitals can lose millions of dollars a year in funding for care related to these complicated contributing conditions. If we don't document "pink elephant present" in the chart, even though the elephant took a giant pink poop on the chart, hospitals won't get paid extra for the effort. Nothing can be assumed, except the assumption that we must assume no common sense is present.

This is why hospitalist physicians are so valuable to hospitals and why hospitals are willing to pay hospitalists over $130,000 per hospitalist per year to subsidize and support hospitalist salaries. Evaluation and management economics have failed miserably to capture the 57 million dollar hospitalist advantage on the back end. Hospitals are willing to pay for that value when they get buy-in from hospitalists on these types of accounting games forced upon us by unfunded government mandates. Remember doctors, these are the dollars that allow hospitals to provide all that free food in the doctor's lounge. You won't find any hospital Foundation supporting that amenity.

So how much does a hip fracture surgery cost at Banner Thunderbird hospital in Phoenix, AZ? In my father's case, it was a hip pinning which is different from a total or partial joint replacement, but it was hip fracture surgery none the less. Transparency is difficult in health care because many medically necessary and medically unnecessary cares provided are only known after the fact. Here is a review of what the hospital charged for his eight day hospital stay and how much the hospital agreed to accept from Medicare as payment in full.

Total Charges and Allowable Medicare Payments for Hip Fracture Repair at Banner Thunderbird Hospital In Phoenix, AZ (2012)



Inpatient Charges (2012) For Hip Fracture Repair at Banner Thunderbird Hospital


As you can see, the hospital charged $56,867.10 for my father's eight day hospital stay for his hip fracture. The hospital agreed to accept $19,688.50 at payment in full. The $1,156 deductible was included in the charge and was paid for by his supplemental Medicare policy. What a hospital charges and what they collect are always going to be different. Is it reasonable to pay a $400 facility fee for an EKG? Is $43.70 reasonable for a dip stick urinalysis? Is $6,000 for a hip grade titanium nail reasonable?

You decide. These types of charges are why patients get furious when their home medications are not paid for under DRG economics of observation hospitals stays. If a hospital is going to charge $40 for a urinalysis, they are going to charge $40 for a home dose of lisinopril.

On the other hand, is Medicare's payment of 34.6% on the charged dollar an acceptable amount? Can hospitals continue to survive when Medicare and Medicaid payments continue to pressure margins? Will their demise accelerate under ObamaCare's promise to decimate hospital funding under the current subsidizing private market? Questions to think about in the next few years. I guarantee you'll hear more and more about hospitals shutting down, especially in the inner cities and the people in these communities demanding their government save them with money they don't have.

With that said, how much did all the physicians get paid for their care during my father's 8 day hospital stay? In the table below, the first column is the charge submitted by the physician. The second charge is the payment the physician has agreed to accept from Medicare. How long will they continue to accept these rates?

Total Physician Charges For Hip Fracture Surgery (2012)






What where the totals billed and totals paid to these physicians?

Total charges submitted by physicians were $6,747.24 during this eight day hip fracture hospital admission (less than 11.8% of what the hospital submitted for their charges) . The total agreed upon allowable charges to these physicians from Medicare was $2,539.64 (12.9% of what the hospital was paid for their services). 40% of the paid amount went to the orthopaedic surgeon for this surgical effort and his 90 day global period in which his assistant cares for all his brief daily hospital follow up visits and an office visit or two in the following month.

In other words, these physicians have agreed to accept 37.7% of their billed dollar as payment in full from Medicare for their services. On January 1st, 2012, if Congress fails to act, physician compensation will experience an across the board cut of approximately 27.5% due to the failed SGR economics implemented by Congress nearly 20 years ago.

If one were to apply that cut to these physicians caring for my father on January 2nd, 2013, Medicare would only agree to pay the combined total of $1,841,21 for allowing the ER doctor, the radiologist, the anesthesiologist, hospitalist, neurologist, the gastroenterologist, oh, and the surgeon the right to take care of him for eight long and difficult days. That's only 27% of the billable dollar. For many states, that's what their Medicaid rates allow. And that's why many Medicaid patients can't find a doctor.

How expensive is hip fracture surgery in Phoenix, Arizona? Over $20,000 in this case. As described, just over 10% of that was provided to all the physicians who cared for him for over a week. I believe Joe Public wants to believe physicians are getting rich off of Medicare and could care less if physicians rates were slashed. If they understood what physicians actually earned from Medicare for taking care of the complicated elderly and disabled in this country, they would better appreciate how grave the current financing holes really are and why entitlement reform must move forward onto the backs of the beneficiaries.

And when ObamaCare presents its ugly head with the insurance exchanges and businesses abandon health care benefits en mass and private insurance payments plummet on the health exchanges, I believe more and more physicians are simply going to opt out of all insurance in favor of concierge practices supported by middle class and upper class patients willing to pay for the right to access physician expertise and education. I recommend those that can should start maximizing their HSA contributions. They're going to need all the help they can get.

 

[Spinach Dip]

The "average person" (and I use that term in its vaguest possible sense) think all doctors are millionaires and spend 6 days out of every week jet-skiing and relaxing at their private villa on the lake.

Most of them think doctors are overpaid and underworked. And when you see some of these charges ($6,000 for a nail? (granted, a special nail, but still.....)), one can understand how that point of view is fostered.



BTW, this line is win:

I believe Joe Public wants to believe physicians are getting rich off of Medicare and could care less if physicians rates were slashed. If they understood what physicians actually earned from Medicare for taking care of the complicated elderly and disabled in this country, they would better appreciate how grave the current financing holes really are