Should The GOP be using Obamacare like this?

[copperhead]

LOL, Actually i was watching a documentary recently that was discussing how in the future out toilets will be a diagnostic device and scan your shit (Litterally) ever time you go.

 

I'm sure that will be be set up to automatically upload everything to ratemypoo.com

[Brandon]

So, serious question, why didn't you say 'no'? I vaguely remember a thread where you stated you were going to only accept cash at your practice...are you not legally allowed to do that? Can you not send this pill popping twat away?

 

Can you require a credit check before performing surgery on someone without insurance?

 

I know this sounds cold hearted but I am 100% serious. I give thousands of dollars a year and hours upon hours of my time to different charities throughout central Ohio each year. I love to help those in need...but only when they are willing to try and help themselves. I HATE that I am being forced now, more than ever, to carry dead weight.

-Marc

 

*edit* That Iphone is probably an Obama phone. I honestly thought that was a joke until I was driving on Morse Rd and saw a wireless carrier preaching "Free Government Cell Phones and Service INCLUDING DATA!". I wanted to pull over and burn it down.

 

 

That whole cash vs. insurance thing at the offices really irks me to....

 

Why is it you can bill and insurance company 4x,10x what you would (Doc. Office) would quote the cash payers??? Do doctors feel all warm and cuddly inside when they "strike" a cash deal vs waiting 30-60 days on the insurance check they charged 4x for?

 

Simple example,

 

I go in to have and in grown facial hair removed at my Dermo. I ask them what the insurance code is for this service...He says he cant give that to me at first, I say "good I cant give you my insurance info or money then"... Dermo then gets nurse, pulls codes gives me the code. I bust out my cell, call my insurance company in front of him, they cover 80% (during the call he had a just dumbfounded look). I then ask, what will be the billing cost of the code, he said do you want a cash price or insurance cost...I chuckle, and say come again. Dermo says well I can quote you a cash payment plan or we will just bill your insurance. I said how about you quote me the cost you will charge me, it should be the same for my insurance and my cash, both are payment forms you receive; and I will determine if I choose you for my service. He claims its not that easy...IN GROWN HAIR COME THE FUCK ON, you gave me the codes you planned to bill I know there could be a small buffer once you cut my cheek open, but you should be 95% able to quote this. So we discussed more, all the while he thinks I am a poor nut and not willing to pay the "20%" of god knows what...Dermo has had enough of informed patient, then gets his "office manager in the room"...Oh boy a 25 year old twit witted women with giant fake boobs, lips, ect blowing the doc on the side, whom just says I am crazy and people don't ask what things cost and they don't quote them...All the while I am turning the wheels in my mind, can this really be happening. Yes. So After we couldn't firm up the "cost" I said cool, grabbed my jacket walked out, told them all to have a nice day. Dermo comes into the waiting area as I am leaving, asks why I left. In front of 20 people, I off course rather boisterously said, "doc, you need to inform patients of the costs, plain and simple I am with in my rights to ask, and if you choose not to provide me with that information and want to play deception, then I will choose to go to a different doc". He was pretty well shook up then that a scruffy bearded bald guy turned his "holy-ness" down.

 

Why should I just "pray" my 20% wasn't going to be say 500 dollars, when they might have done the whole thing for cash for 200 dollars, its robbery from the patient perspective, and likely insurance perspective. TELL ME WHAT IT WILL FUCKING COST, simple procedures have simple costs, this is not a open heart bypass. Doctors invoice line items like any other business, why all the confusion.

 

While I see Kirks point, Marcs point, Austins point in regard to the blatant abuse and use of the healthcare laws and system, there is also this side. The lazy corrupt and we don't have to tell you what we are doing what we are charging side. We went to med school, we are so smart, we deserve to charge whatever we wish, hush you sick person you cant ask what things cost how dare you. It irritates me that many doctors believe they are too "smart" to explain simple business practice (giving health care) to me, and or the procedure. lt is like their IQ is so high I just hit the powerball to sit in a room and soak in their residue, lucky me. (disclaimer not all doctors are like this I play soccer with several and have several I associate with, and they agree there are plenty like this however... ironically most of whom are in plastic surgery and dermo).

 

The fact is there is no easy fix, duh. However this particular segment irks me. Quote a cost, bill the cost, plus or minus a small percentage. Maybe the pork is necessary for all the free loaders I suppose...

 

In the end, if ACA isn't good enough for congress, it isn't good enough for me, didn't we vote them in our OUR behalf...HA crickey that's funny.

Edited October 3, 2013 by Brandon

[thorne]

I'm sure that will be be set up to automatically upload everything to ratemypoo.com

 

 

It will be an APP LOL

[SpaceGhost]

That whole cash vs. insurance thing at the offices really irks me to....

 

Why is it you can bill and insurance company 4x,10x what you would (Doc. Office) would quote the cash payers??? Do doctors feel all warm and cuddly inside when they "strike" a cash deal vs waiting 30-60 days on the insurance check they charged 4x for?

 

Simple example,

 

I go in to have and in grown facial hair removed at my Dermo. I ask them what the insurance code is for this service...He says he cant give that to me at first, I say "good I cant give you my insurance info or money then"... Dermo then gets nurse, pulls codes gives me the code. I bust out my cell, call my insurance company in front of him, they cover 80% (during the call he had a just dumbfounded look). I then ask, what will be the billing cost of the code, he said do you want a cash price or insurance cost...I chuckle, and say come again. Dermo says well I can quote you a cash payment plan or we will just bill your insurance. I said how about you quote me the cost you will charge me, it should be the same for my insurance and my cash, both are payment forms you receive; and I will determine if I choose you for my service. He claims its not that easy...IN GROWN HAIR COME THE FUCK ON, you gave me the codes you planned to bill I know there could be a small buffer once you cut my cheek open, but you should be 95% able to quote this. So we discussed more, all the while he thinks I am a poor nut and not willing to pay the "20%" of god knows what...Dermo has had enough of informed patient, then gets his "office manager in the room"...Oh boy a 25 year old twit witted women with giant fake boobs, lips, ect blowing the doc on the side, whom just says I am crazy and people don't ask what things cost and they don't quote them...All the while I am turning the wheels in my mind, can this really be happening. Yes. So After we couldn't firm up the "cost" I said cool, grabbed my jacket walked out, told them all to have a nice day. Dermo comes into the waiting area as I am leaving, asks why I left. In front of 20 people, I off course rather boisterously said, "doc, you need to inform patients of the costs, plain and simple I am with in my rights to ask, and if you choose not to provide me with that information and want to play deception, then I will choose to go to a different doc". He was pretty well shook up then that a scruffy bearded bald guy turned his "holy-ness" down.

 

Why should I just "pray" my 20% wasn't going to be say 500 dollars, when they might have done the whole thing for cash for 200 dollars, its robbery from the patient perspective, and likely insurance perspective. TELL ME WHAT IT WILL FUCKING COST, simple procedures have simple costs, this is not a open heart bypass. Doctors invoice line items like any other business, why all the confusion.

 

While I see Kirks point, Marcs point, Austins point in regard to the blatant abuse and use of the healthcare laws and system, there is also this side. The lazy corrupt and we don't have to tell you what we are doing what we are charging side. We went to med school, we are so smart, we deserve to charge whatever we wish, hush you sick person you cant ask what things cost how dare you. It irritates me that many doctors believe they are too "smart" to explain simple business practice (giving health care) to me, and or the procedure. lt is like their IQ is so high I just hit the powerball to sit in a room and soak in their residue, lucky me. (disclaimer not all doctors are like this I play soccer with several and have several I associate with, and they agree there are plenty like this however... ironically most of whom are in plastic surgery and dermo).

 

The fact is there is no easy fix, duh. However this particular segment irks me. Quote a cost, bill the cost, plus or minus a small percentage. Maybe the pork is necessary for all the free loaders I suppose...

 

In the end, if ACA isn't good enough for congress, it isn't good enough for me, didn't we vote them in our OUR behalf...HA crickey that's funny.

 

I agree. It's bullshit.

[kirks5oh]

That whole cash vs. insurance thing at the offices really irks me to....

 

Why is it you can bill and insurance company 4x,10x what you would (Doc. Office) would quote the cash payers??? Do doctors feel all warm and cuddly inside when they "strike" a cash deal vs waiting 30-60 days on the insurance check they charged 4x for?

 

Simple example,

 

I go in to have and in grown facial hair removed at my Dermo. I ask them what the insurance code is for this service...He says he cant give that to me at first, I say "good I cant give you my insurance info or money then"... Dermo then gets nurse, pulls codes gives me the code. I bust out my cell, call my insurance company in front of him, they cover 80% (during the call he had a just dumbfounded look). I then ask, what will be the billing cost of the code, he said do you want a cash price or insurance cost...I chuckle, and say come again. Dermo says well I can quote you a cash payment plan or we will just bill your insurance. I said how about you quote me the cost you will charge me, it should be the same for my insurance and my cash, both are payment forms you receive; and I will determine if I choose you for my service. He claims its not that easy...IN GROWN HAIR COME THE FUCK ON, you gave me the codes you planned to bill I know there could be a small buffer once you cut my cheek open, but you should be 95% able to quote this. So we discussed more, all the while he thinks I am a poor nut and not willing to pay the "20%" of god knows what...Dermo has had enough of informed patient, then gets his "office manager in the room"...Oh boy a 25 year old twit witted women with giant fake boobs, lips, ect blowing the doc on the side, whom just says I am crazy and people don't ask what things cost and they don't quote them...All the while I am turning the wheels in my mind, can this really be happening. Yes. So After we couldn't firm up the "cost" I said cool, grabbed my jacket walked out, told them all to have a nice day. Dermo comes into the waiting area as I am leaving, asks why I left. In front of 20 people, I off course rather boisterously said, "doc, you need to inform patients of the costs, plain and simple I am with in my rights to ask, and if you choose not to provide me with that information and want to play deception, then I will choose to go to a different doc". He was pretty well shook up then that a scruffy bearded bald guy turned his "holy-ness" down.

 

Why should I just "pray" my 20% wasn't going to be say 500 dollars, when they might have done the whole thing for cash for 200 dollars, its robbery from the patient perspective, and likely insurance perspective. TELL ME WHAT IT WILL FUCKING COST, simple procedures have simple costs, this is not a open heart bypass. Doctors invoice line items like any other business, why all the confusion.

 

While I see Kirks point, Marcs point, Austins point in regard to the blatant abuse and use of the healthcare laws and system, there is also this side. The lazy corrupt and we don't have to tell you what we are doing what we are charging side. We went to med school, we are so smart, we deserve to charge whatever we wish, hush you sick person you cant ask what things cost how dare you. It irritates me that many doctors believe they are too "smart" to explain simple business practice (giving health care) to me, and or the procedure. lt is like their IQ is so high I just hit the powerball to sit in a room and soak in their residue, lucky me. (disclaimer not all doctors are like this I play soccer with several and have several I associate with, and they agree there are plenty like this however... ironically most of whom are in plastic surgery and dermo).

 

The fact is there is no easy fix, duh. However this particular segment irks me. Quote a cost, bill the cost, plus or minus a small percentage. Maybe the pork is necessary for all the free loaders I suppose...

 

In the end, if ACA isn't good enough for congress, it isn't good enough for me, didn't we vote them in our OUR behalf...HA crickey that's funny.

 

obviously you have some kind of chip on your shoulder about the situation. when a patient asks me how much a procedure is going to cost i refer them to our billing department, and they are able to quote a price, and how much is covered by insurance, etc, etc. the patient knows well in advance of surgery how much will be covered, and what the costs are.

 

the truth is that i have no fucking clue what the patient is billed for the procedure in most cases, and its not my job to determine that--i can't simply set my prices---the price is dictated by a multitude of factors over which i have ZERO FUCKING CONTROL. would your rather have your doctor be an expert at billing, etc., or an expert at fixing your health problem?

[SpaceGhost]

obviously you have some kind of chip on your shoulder about the situation. when a patient asks me how much a procedure is going to cost i refer them to our billing department, and they are able to quote a price, and how much is covered by insurance, etc, etc. the patient knows well in advance of surgery how much will be covered, and what the costs are.

 

the truth is that i have no fucking clue what the patient is billed for the procedure in most cases, and its not my job to determine that--i can't simply set my prices---the price is dictated by a multitude of factors over which i have ZERO FUCKING CONTROL. would your rather have your doctor be an expert at billing, etc., or an expert at fixing your health problem?

 

For you yes, but most Dermatologists own their own practice and are small. I'd also like to point out I can't get an appointment to see one here in central ohio for 60 days. Their billing people are in the office. They work the same hours the practice is open. My mom used to work for central ohio skin and cancer in billing. Since it's pretty hard to get into a dermatologist and they know it, they most likely didn't give any fucks. I get hospitals will have a hard time in this, but if you own/run a small practice, and have something out patient you want scheduled, I see no reason why you can't have both prices...

[Brandon]

obviously you have some kind of chip on your shoulder about the situation. when a patient asks me how much a procedure is going to cost i refer them to our billing department, and they are able to quote a price, and how much is covered by insurance, etc, etc. the patient knows well in advance of surgery how much will be covered, and what the costs are.

 

the truth is that i have no fucking clue what the patient is billed for the procedure in most cases, and its not my job to determine that--i can't simply set my prices---the price is dictated by a multitude of factors over which i have ZERO FUCKING CONTROL. would your rather have your doctor be an expert at billing, etc., or an expert at fixing your health problem?

 

So if you are in private practice...You as the private practice doctor do not control any pricing at all, not one ounce?

 

Maybe in a corporate practice with trinity or whom ever, yes billing handles all of this. You get to focus on you're part, the health care which is good.

 

Obviously in your shoes as a ortho surgeon your procedures are costly...And of course your billing dept meets with the patient to go over a 10k service to insure they are shielding themselves from potential risk of non payment. However how can their be a cash price, and insurance price? Why are they not the same? Discount for cash went out the window quite some time ago it seems. Honestly I don't care if I talk to a doc about payment or their billing, so long as its accurate and truthful; likely you're right, you as KirkOh surgeon focus on surgery that is your JOB, and Molly in billing focus on billing that is her JOB.

 

 

 

My point is consistency...Seems there would be a lot less "free loaders" if people knew what things really cost, and had a choice...I suppose I give to much faith to the free loaders. Maybe this would just help the hard on your luck folks.

 

Maybe you're right, maybe I have a chip on my shoulder...History serves me this.

 

Another example. More relative to your field.

 

I am a very active guy, and rather fit, in fact I am probably one of the healthiest members on this forum (sorry fellas GET ON MA LEVEL lolz). I play soccer, mt bike, rd bike, tri athlete, lift training, pump in run top 15 at the Arnold ect. Now I do occasionally tear and ACL and have ankle injuries.

 

I will make this shorter, go to ortho on what I thought was a broken ankle, holy cow it was black and blue everywhere and as big as I have ever had a sprained ankle (normally I wouldn't go in for a sprain had to many, same outcome 3-6 weeks). Go in get x ray - neg - grade 2-3. Doc says take this brace, it will help. Cool. How much is the brace? Don't know Ill get the chic to find out. Cool. Chic comes in, says she will just bill my insurance. I say, well then give me the billing cost for the insurance, I know my insurer only covers 60% (due to prior events)... Comes back literally 25 minutes later, says this fancy ASO brace deal is 680 dollars... This is what we will bill the insurance. OKAY this brace is made from endangered sheep in wales then...Best part I have the brace sitting next to me, I use amazon price scanner, scan the UPC, low and behold I can buy it online ALL OVER the place for 80 dollars...same brace. Politely I refuse the brace and ordered one sitting there from my phone.

 

I could have been like every other idiot patient walked off with the brace, and then called in 3 weeks later pissed off I now owe you 272 dollars (which I had but I am sure others don't) for the 40% I didn't know was covered.

 

How is it right to bill these prices? More pork for the free loaders I suppose...Like I mentioned, Doc's put in LOTS of work, LOTS of time to get a return at 40 for great income. They are very much worth the wages, however it seems the costs of things if opened up, would be much better regulated and fair, and maybe even reduce non payments.

[thorne]

The cost of Durable Medical equipment is off the hook, I used to be on a CPAP machine and they charged me like 75$ a month. I found the same machine online for 150.

 

The markup on healthcare is insane, I am honestly unsure what someone like Kirk makes per year, I do know that he paid a shit ton for the college to get him to that income level.

 

It's very similar to car repair . When you pay 85$ an hour to some shop your paying for the lights. your paying for the building. Your paying for the mistake someone made. your paying for the guy who stole his car and left a 11K bill. The mechanic/tech is the smallest piece of that cost (~25-30%)

[kirks5oh]

The cost of Durable Medical equipment is off the hook, I used to be on a CPAP machine and they charged me like 75$ a month. I found the same machine online for 150.

 

The markup on healthcare is insane, I am honestly unsure what someone like Kirk makes per year, I do know that he paid a shit ton for the college to get him to that income level.

 

It's very similar to car repair . When you pay 85$ an hour to some shop your paying for the lights. your paying for the building. Your paying for the mistake someone made. your paying for the guy who stole his car and left a 11K bill. The mechanic/tech is the smallest piece of that cost (~25-30%)

 

 

what the hospital/clinic bills, and what they receive from the insurance company are two completely different things. back up a couple pages and read my question about knee replacement surgery. what do you think i get paid as a surgeon to replace a knee or a hip, keeping in mind the cost covers the 40 minute preop visit in my office, the 1.5 hour surgery, seeing the patient each day while they are in the hospital (dressing changes, etc), and seeing them several times in the office for the 3 month recovery. what do you think the surgeon "makes" for something like that?

[Brandon]

what the hospital/clinic bills, and what they receive from the insurance company are two completely different things. back up a couple pages and read my question about knee replacement surgery. what do you think i get paid as a surgeon to replace a knee or a hip, keeping in mind the cost covers the 40 minute preop visit in my office, the 1.5 hour surgery, seeing the patient each day while they are in the hospital (dressing changes, etc), and seeing them several times in the office for the 3 month recovery. what do you think the surgeon "makes" for something like that?

 

2500

[RedRocket1647545505]

5-10% of total bill

[kirks5oh]

5-10% of total bill

 

the total bill for a knee replacement could be upwards of $50k.

 

 

 

i get $1250. again, that's what i get for the preop visit, the surgery, the hospital rounding, and the three months of postoperative visits. out of that $1250, i have to pay between 30-40% for overhead---that is for malpractice insurance, to pay for the office, the supplies, the nursing staff, etc.

 

so the number becomes less than $800. after i pay taxes on that money, my actual net payment from this surgery is just north of $500. people think we get paid $10k to do this surgery.

[Crash1647545504]

 

i get $1250. again, that's what i get for the preop visit, the surgery, the hospital rounding, and the three months of postoperative visits. out of that $1250, i have to pay between 30-40% for overhead---that is for malpractice insurance, to pay for the office, the supplies, the nursing staff, etc.

 

so the number becomes less than $800. after i pay taxes on that money, my actual net payment from this surgery is just north of $500. people think we get paid $10k to do this surgery.

 

Is this why doctors are in and out in in 10 seconds? I feel visits are so short, you are attacked with a bunch of big words and before you have a chance to relise what happens the doctor is gone, and you standing in the billing department still processing what was just said. It's either two weeks before you see him again or it takes forever to track them down if you are admitted.

 

I don't mean to attack you personally, I've had good excperiances with Docs too. But for the most part they don't even know you, or want to. For the times I have brought it up, it's like this huge suprise that we pay out of pocket. "Oh!, your paying yourself? In that case you don't need this $500 boot we can use this $150 one," or "you don't need four follow up visits, two will be just fine" I make it a point now to let the doc know my situation because I expect to get the most expensive treatment.

[kirks5oh]

Is this why doctors are in and out in in 10 seconds? I feel visits are so short, you are attacked with a bunch of big words and before you have a chance to relise what happens the doctor is gone, and you standing in the billing department still processing what was just said. It's either two weeks before you see him again or it takes forever to track them down if you are admitted.

 

I don't mean to attack you personally, I've had good excperiances with Docs too. But for the most part they don't even know you, or want to. For the times I have brought it up, it's like this huge suprise that we pay out of pocket. "Oh!, your paying yourself? In that case you don't need this $500 boot we can use this $150 one," or "you don't need four follow up visits, two will be just fine" I make it a point now to let the doc know my situation because I expect to get the most expensive treatment.

 

dr's are in and out in 10 seconds because they have that many more patients to see. my average tuesday office is 60 patients. most of the time, i don't even get a chance to piss until lunch. and my lunch is usually between patients. its crazy, but that's how it is. there is simply not enough time in the day. in order for most dr's offices to be profitable, they have to see more patients as reimbursement goes down, and fixed costs (overhead, malpractice) go up. it is simply not possible for female family doctors to work part time--this used to be common practice, but it is no longer feasible. they simply can't make a profit.

 

family physicians used to deliver babies. because they don't do surgery, and don't do it enough, the malpractice insurance has risen to the point where they cannot do this any longer. when someone comes into my office and has no money, yet is deserving, i might give them a cortisone shot in the knee for free--no charge, no bill, no nothing. this is not exactly legal---it could be considered fraud, but in certain circumstances it is the right thing to do, and maybe worth it (from a moral standpoint). like i said, i don't set the charges, have no control over them, and am just as likely to get in trouble if i omit charges or add charges that were not done.

[1fast5gp]

the total bill for a knee replacement could be upwards of $50k.

 

 

 

i get $1250. again, that's what i get for the preop visit, the surgery, the hospital rounding, and the three months of postoperative visits. out of that $1250, i have to pay between 30-40% for overhead---that is for malpractice insurance, to pay for the office, the supplies, the nursing staff, etc.

 

so the number becomes less than $800. after i pay taxes on that money, my actual net payment from this surgery is just north of $500. people think we get paid $10k to do this surgery.

 

So do you average like 300-400 surgeries a year?

[1fast5gp]

What I hate is this in network out of network bullshit when it comes to surgerys. Most surgeries require a surgeon, assistant surgeon and anesthesiologist. Even if your surgeon is in network, sometimes the assistant surgeon and anesthesiologist isn't and you are end up paying a ton more than you expect out of pocket. The billing code is so complicated that it is almost impossible to know what you are going to have to pay before you go into the surgery.

[1fast5gp]

dr's are in and out in 10 seconds because they have that many more patients to see. my average tuesday office is 60 patients. most of the time, i don't even get a chance to piss until lunch. and my lunch is usually between patients. its crazy, but that's how it is. there is simply not enough time in the day. in order for most dr's offices to be profitable, they have to see more patients as reimbursement goes down, and fixed costs (overhead, malpractice) go up. it is simply not possible for female family doctors to work part time--this used to be common practice, but it is no longer feasible. they simply can't make a profit.

 

family physicians used to deliver babies. because they don't do surgery, and don't do it enough, the malpractice insurance has risen to the point where they cannot do this any longer. when someone comes into my office and has no money, yet is deserving, i might give them a cortisone shot in the knee for free--no charge, no bill, no nothing. this is not exactly legal---it could be considered fraud, but in certain circumstances it is the right thing to do, and maybe worth it (from a moral standpoint). like i said, i don't set the charges, have no control over them, and am just as likely to get in trouble if i omit charges or add charges that were not done.

 

It's true, malpractice insurance is through the roof. Pretty much mostly due to frivolious lawsuits. Cost of insurance for surgeons go up, it gets passed on to the patients. One of the key points in Obamacare is to reduce wasteful spending in hospitals but missed the key causes of the wasteful spendings. Most Drs are running unnecesssary tests and procedures to cover their own asses from malpractice law suits. They need to start with medical malpractice reform and regulate the insurance companies.

[kirks5oh]

So do you average like 300-400 surgeries a year?

 

more.

 

but i do 300-400 joint replacements

[AngryBMW]

Patient: RK

Sex: Female

Age: ~50

 

Hx: Diabeetus

 

Admitted: 9/30/13

Dx: DKA

Last date of discharge: 9/16/13, 8/24/13, 7/20/13, 5/23/13, etc...

Discharge EDU on diet, exercise, medications, etc, provided at every discharge.

 

Last prescriptions for insulin filled: 9/1/13, 8/1/13, 7/1/13, etc....

 

Pt. arrives to hospital in a lethargic state. Blood Glucose >1,100. Alert/Oriented x0; will not follow commands, (+) acetone/ketones, Head filled w/ lice. Cockroach found crawling out of giner by ED staff.

 

Tx:

-2-3 day ICU stay: (~$1,000/day)

-1-2 day MedSurg stay (post ICU): ~$600/day

-Head CT d/t lethargy: $x,xxx??? (Multimillion dollar machine)

-24/7 supervision by nursing staff: $25-35/hr x 3-5days

-Medications (including delousing)

-Monitoring

-Frequent blood draws:~500/ea.

-Support staff pay

-Physician pay

 

Pt bill: Probably $10,000+. Every. Single. Visit.

She pays: $0

Hospital gets reimbursed by Medicaid: $0 (Dinged for <30day readmission).

 

This patient gets the same exact treatment every single time she is here. Pt. has had complete care given to her over this time. Education is, yet again, provided on how to care for her disease. Pt. meds are provided to her. Syringes are provided to here. Glucometer is provided to her. Yet, she ends up back here every month for the same thing, just because she's non-compliant.

 

These patients abound. Every non-compliant patient that walks through the door is a hit to the hospitals checkbook. You pay for these people as well.

 

My girlfriend is a RN at OSU on the GI/Infectious Disease floor and has 100000 stories like this. Repeat patients, same shit, and to boot they are rude, nasty, and do not listen to the RN or DR.

 

My Mom was an ER RN for 20+ years and had even worse stories. I honestly don't know how you guys do it.

 

I'm a hospital employee, and our hospital is a non-profit org. We cannot turn people away who need care. The elbow had to be fixed. We have programs for people who have zero insurance to get elective surgery such as a knee replacement. I pick these patients carefully--if I can do 3 of these a year they are deserving people just down on their luck.

 

You're a better man than me. I couldn't handle that kind of person day in and day out.

 

Not if you're gonna subsidize it anyways. I pay for it at the hospital, or I pay for it in my taxes. I have a choice to go to the hospital. I don't have much choice when it comes to taxes.

 

By cutting the freeloading, I mean pull the fucking rug out from under these people to get them off their lazy asses. No subsidies. Just work. Like the rest of us.

 

You should work in hospital administration. See what you can get done

 

I almost feel like Dr's at least when it comes to routine care are going to be trivialized to an extent thanks to software and technology. Yes the human aspect matters and i understand that allot of instict goes into it. But as technology moves forward the devices we use to diagnose become more powerful.

 

The price of healthcare should be going down due to the advances in technology. Jobs adapt over time and I think were seeing that now in healthcare. It happens in every industry.

Tricorders in every home, paid for by Comrade Obama. This is on page 5,953 of the Affordable Care Act, to be implemented in year 6. You'd know this if you had read it.

 

This is a very scary prospect. Right here in Ohio there is a team of doctors developing software where they will be in one remote location and be able to 'see' 5 times the patients by diagnosing through telecommunication. I'm talking high end cameras and TV's in the patients room and having a nurse and NP with the patient. Talk about trying to streamline the process. Is this something you would be comfortable with??

 

That whole cash vs. insurance thing at the offices really irks me to....

 

Why is it you can bill and insurance company 4x,10x what you would (Doc. Office) would quote the cash payers??? Do doctors feel all warm and cuddly inside when they "strike" a cash deal vs waiting 30-60 days on the insurance check they charged 4x for?

 

....

 

In the end, if ACA isn't good enough for congress, it isn't good enough for me, didn't we vote them in our OUR behalf...HA crickey that's funny.

 

This doesn't really bother me at all. Look at it like buying a car; will you get a better deal stroking a check or financing it?

 

You have had a lot of surgeries etc in the past 2 years so you should be very well versed in reading your EOB and medical billing (as you have pointed out in this thread).

 

It makes complete sense to me that a DR would have a cash price be less than the insurance price as cash, once paid, is completely paid. There is no dicking around with the insurance company just hoping that they will agree to pay the bill. Having had 4 different insurance companies in the past 4 years I have found that certain companies will pay more or less for a procedure than other companies. That means that a DR is guaranteed more or less money from each individual insurance company as that is the only money they are guaranteed. If you get a bill for $x after insurance covered $y and don't have the money, it appears an overwhelming number of Americans will say 'fuck it' and not pay. Who gets screwed here? The DR and their company. So, by lowering the cash price to cover exactly what they need but guarantee their money seems like a pretty savvy business model to me. This is again why I am considering dropping my major medical and simply paying cash.

 

more.

 

but i do 300-400 joint replacements

 

Good. Bust your ass because there are thousands sucking on the .gov tit that rely on your tax dollars!

 

In all seriousness, I never blame a DR for the price. As you have pointed out, it really isn't your job to determine the cost; it is your job to perform exceptional work and fix what ails me.

 

No, I don't know how to fix the problem other than stop helping those that refuse to help themselves and let Darwinism take over.

-Marc

[RedRocket1647545505]

This is a very scary prospect. Right here in Ohio there is a team of doctors developing software where they will be in one remote location and be able to 'see' 5 times the patients by diagnosing through telecommunication. I'm talking high end cameras and TV's in the patients room and having a nurse and NP with the patient. Talk about trying to streamline the process. Is this something you would be comfortable with??

 

This stuff is already out there, in use. Our little rural hospital has a contract with Ohio Health for their TeleStroke network. Essentially, a patient presents to the ED with stroke-like symptoms. The staff fires up the Telestroke shit, where a neurologist from Ohio Health assesses the patient, and makes the call on what to do with them from there. It's pretty basic, but it's getting more and more involved.

 

Our own ICU has talked about converting to an "e-ICU" in an attempt to save monitoring costs. What it amounts to is a VERY hi-def camera mounted on the wall closest to the foot of each ICU bed. The camera faces the wall until activated to avoid the feeling of being spied on. The hospital contracts with a monitoring company (I think they're in Cinci) to assess the patient at regular intervals in the hopes that they can catch something we don't, or before we do, as well as to cut back on our staff. The monitoring staff has access to all the same telemetry monitoring that we do and are supposed to sit there and monitor the patient 24/7. Should we need a doctor immediately, we would be able to speak directly with the monitoring company who has a Dr. right there as well. While I do not feel that it is a bad idea to have additional monitoring of a patient, I do not think it a good idea to replace physical, on-site staff with someone who's 150miles away.

 

My mother, who's about to finish her MSN/MBA program, did a large project on telemedicine, and, like it or not, it's coming. I assume it's mostly driven by the desire to save costs, which isn't always a good thing. Everyone's going to have access to healthcare (!), but who knows how good that healthcare is going to be in the future.

[AngryBMW]

This stuff is already out there, in use. Our little rural hospital has a contract with Ohio Health for their TeleStroke network. Essentially, a patient presents to the ED with stroke-like symptoms. The staff fires up the Telestroke shit, where a neurologist from Ohio Health assesses the patient, and makes the call on what to do with them from there. It's pretty basic, but it's getting more and more involved.

 

Our own ICU has talked about converting to an "e-ICU" in an attempt to save monitoring costs. What it amounts to is a VERY hi-def camera mounted on the wall closest to the foot of each ICU bed. The camera faces the wall until activated to avoid the feeling of being spied on. The hospital contracts with a monitoring company (I think they're in Cinci) to assess the patient at regular intervals in the hopes that they can catch something we don't, or before we do, as well as to cut back on our staff. The monitoring staff has access to all the same telemetry monitoring that we do and are supposed to sit there and monitor the patient 24/7. Should we need a doctor immediately, we would be able to speak directly with the monitoring company who has a Dr. right there as well. While I do not feel that it is a bad idea to have additional monitoring of a patient, I do not think it a good idea to replace physical, on-site staff with someone who's 150miles away.

 

My mother, who's about to finish her MSN/MBA program, did a large project on telemedicine, and, like it or not, it's coming. I assume it's mostly driven by the desire to save costs, which isn't always a good thing. Everyone's going to have access to healthcare (!), but who knows how good that healthcare is going to be in the future.

 

Like I said, scary as shit. If I am in the hospital, I EXPECT to be seen and cared for by a live, well trained individual. That's what I am paying for.

 

This telemedicine may save costs to the hospital but will not lower the cost to the patient. I do not see the benefit to the consumer.

 

I do agree that having a monitoring system like that to HELP the flesh and blood RN/NP/DR is a great thing but DO NOT think it should replace them!

-Marc

[Crash1647545504]

Like I said, scary as shit. If I am in the hospital, I EXPECT to be seen and cared for by a live, well trained individual. That's what I am paying for.

 

I agree. It's just another way doctors will become more disconected from their patients. There should be more obligation to learn about the person you are treating. Person to person is important. Talking into a mic of a camera while someone "examins" you from elsewere doesn't seem right.

[buelliganx1]

Person to person is important. Talking into a mic of a camera while someone "examins" you from elsewere doesn't seem right.

 

I agree, when my uncle had a stroke a few years ago the doc came out and told my aunt who had been married to my uncle for over 30 years at the time that there is nothing we can do your husband is going to die. Then he seemed surprised when she broke down into tears. Just like that with as little emotion as someone ordering a meal at McDonalds. Luckily my aunts niece works for a neurosurgeon at the same hospital and when the neurosurgeon found out about my uncle she came in to work while on vacation and immediately took my uncle in to surgery to put a stint in his brain, basically saving his life.

[kirks5oh]

I agree, when my uncle had a stroke a few years ago the doc came out and told my aunt who had been married to my uncle for over 30 years at the time that there is nothing we can do your husband is going to die. Then he seemed surprised when she broke down into tears. Just like that with as little emotion as someone ordering a meal at McDonalds. Luckily my aunts niece works for a neurosurgeon at the same hospital and when the neurosurgeon found out about my uncle she came in to work while on vacation and immediately took my uncle in to surgery to put a stint in his brain, basically saving his life.

 

doctors are normal human beings. some are simply book-smart--and that is how they got into medical school in the first place. they should be doing research somewhere in a dark lab, but they chose patient care for some reason. you talk to them and come away with the thought that they are complete tools/douchebags. they use jargon that you don't understand and assume you will know what they are talking about.

 

some are not book smart at all, they have no logic, and somehow eeked into medical school by interviewing well, and having the minimal mental requirements. you'd be surprised at how successful these people are as physicians. its a 'practice', and most people can learn on the job with time. if you have the people skills, and your patients like you, then you will be infinitely more successful than the guy who is mentally/technically gifted, but an asshole to talk to, with no personal skills.

 

i hate computerized medicine as much as the next person. hate paperwork, hate meetings, hate the fact that i have a foot high stack of papers to sign each week. my perfect day is operating all day, or seeing 50-60 people in the office without all the bullshit. it isn't that way, and will never be that way again.

[thorne]

I personally have no issues with EDoctors. As long as the person running the diagnostic equipment locally and the technology is right It will work. I've spent enough time in the hospital with my wife to know that many times the dr comes in the room its all talk. That means if the dr could sit at his desk and bascilly page each room and discuss he would be more efficient.