Doctor rant...can I please please????

[Dr_Zinj]

Speaking as a physician performance analyst, I'd say you have a legitimate complaint about Dr #4 for probable incompetence and failure to perform. Write up you complaint, make sure you have the names and dates and account number of your visit, and send that to the hospital quality department AND the hospital CEO.

You'll get results, even though it may take 6 months.

 

[IslandTractor]

Speaking as a physician performance analyst, I'd say you have a legitimate complaint about Dr #4 for probable incompetence and failure to perform. Write up you complaint, make sure you have the names and dates and account number of your visit, and send that to the hospital quality department AND the hospital CEO.

You'll get results, even though it may take 6 months.

I agree. While diabetes is clearly not the specialty of a neurologist performing nerve conduction studies, it is simply unacceptable to suspect a serious undiagnosed condition and then make zero effort to either start the work up or at the least make a formal baton pass to someone who can provide appropriate follow up. Telling a patient to get it checked out as you leave the exam room is unacceptable. Frankly, if the patient left and did not seek follow up and then had a serious complication, physician #4 would be guilty of malpractice.

This type of fragmented care is a major weakness of the US healthcare system. We have too many procedure oriented sub specialists who are paid for doing specific tasks rather than caring for the patient. The incentives ($$) for these physicians are not in synch with what is needed for rational, efficient and comprehensive health care.

 

[dave1949]

The healthcare system pricing is abnormal due to employer subsidized insurance. That created a large group of people who are not market conscious/savvy consumers in something that is not a true market. The best thing that could happen would be for employers who subsidize insurance to stop. Give their employees a raise equal to the premium portion the employer currently pays and tell people to go buy health insurance.

I've had a personal health insurance policy for several years with a very high deductible aimed at insuring myself against medical bankruptcy. That was grandfathered in under the ACA rules. At the same time, it began to cover health maintenance procedures as required by the ACA. My colonoscopy in January cost me a total of $98 for a pathology report on one polyp removed.

The hospital list price for a no complications colonoscopy is about $5000 all together. My insurer paid about half that amount and the remainder just disappeared. That is crazy. Who can make sense of it? What would it have cost me before the ACA forced the insurer to cover it? If I were paying that myself because it is less than my deductible, could I ask the hospital how much they would settle for? I suppose I could, but that is just as crazy and no way to run a business.

There is a long ways to go before medical care pricing makes sense to consumers and hospital "list" prices versus actual payment has to be fixed before it will make sense.

 

[IslandTractor]

The healthcare system pricing is abnormal due to employer subsidized insurance. That created a large group of people who are not market conscious/savvy consumers in something that is not a true market. The best thing that could happen would be for employers who subsidize insurance to stop. Give their employees a raise equal to the premium portion the employer currently pays and tell people to go buy health insurance.

I've had a personal health insurance policy for several years with a very high deductible aimed at insuring myself against medical bankruptcy. That was grandfathered in under the ACA rules. At the same time, it began to cover health maintenance procedures as required by the ACA. My colonoscopy in January cost me a total of $98 for a pathology report on one polyp removed.

The hospital list price for a no complications colonoscopy is about $5000 all together. My insurer paid about half that amount and the remainder just disappeared. That is crazy. Who can make sense of it? What would it have cost me before the ACA forced the insurer to cover it? If I were paying that myself because it is less than my deductible, could I ask the hospital how much they would settle for? I suppose I could, but that is just as crazy and no way to run a business.

There is a long ways to go before medical care pricing makes sense to consumers and hospital "list" prices versus actual payment has to be fixed before it will make sense.

I agree with many of your points. The one sticking point for me though in the approach you advocate is that medicine is not like having a kitchen remodel. You cannot realistically get a number of estimates and make an informed decision about which offers the best deal. Sure, you can shop around for an elective MRI and have it done at the least expensive location (MRIs are MRIs, essentially commodity items and if you wanted a different reading you could pay extra for that, zero reason for one setting to charge $500 and another to charge $5000). But you cannot shop around for emergency surgery and unless you live in a major metropolitan area, your ability to find enough physicians and hospitals in true competition with each other is very limited. It isn't really a free market out there. As such, there is a need for the sort of "collective bargaining" on your behalf that an insurer can do. That $5000 charge for a colonoscopy far far exceeds what it actually costs. If your insurer negotiated with the hospital to pay only $2500, you can be quite sure that the hospital still made a goodly profit. However, if you had, as an individual come to the hospital they would have more than likely stonewalled you and charged $5000 or maybe $4500. If they charged less they would run into trouble with their big insurance companies who have deals that say essentially that they will pay half of what the regular charge is. If the hospital let you pay $4000, the insurance company would want to pay only $2000 and that might squeeze the hospital profits.

Medicine is not a free market. We, as consumers, need the protection in that marketplace that only comes with either regulation or negotiating power. The regulatory strategy just ends up creating a static system for the doctors and hospitals to game. The large insurers on the other hand can be flexible but still wield considerable market clout and therefore benefit us. The down side of the insurance strategy is overhead. If you have one big insurer (eg Medicare) then the system supports one chunk of overhead/infrastructure to make things work. If there are 500 insurance companies, then the system needs to support much more overhead and that drives costs up as well as reducing the clout of each individual insurance company in the marketplace. That is why single payer is inherently more efficient.

 

[Travelover]

The healthcare system pricing is abnormal due to employer subsidized insurance. That created a large group of people who are not market conscious/savvy consumers in something that is not a true market. The best thing that could happen would be for employers who subsidize insurance to stop. Give their employees a raise equal to the premium portion the employer currently pays and tell people to go buy health insurance............

I happen to agree. The whole employer paid health care is a remnant of post WWII wage controls, but I digress. If we all paid our own insurance bills, I think that we'd demand much more transparency in pricing of procedures and drug costs.


The really unfair part is that employer provided health care is tax free to the employee, tax deductible to the employer, yet the guy who pays for his own insurance does so with after tax dollars.

 

[JimRB]

Records sharing could be a good thing. If your primary care doctor is on the same system as the hospital and the physicians there might be a chance that your primary care physician had the results of your annual physical which should include diabetes tests along with other blood and urine tests. One goal of the dreaded ACA is the better sharing of records. Of course that means less privacy. You could go to a psychiatrist for stress issues. So now all your doctors can read his diagnosis. Of course that also means that you might not be able to buy a firearm.

There are lots of ambulatory surgery centers pulling the gravy away from hospitals performing colonoscopies, EGDs and other procedures for a whole lot less than a hospital. My wife went for a look at her bladder at a hospital. Her physician did not own her own ASC. The hospital recovery room was $500 and it was their outpatient procedure clinic, not an ER or operating room. A whole lot of money to sit in a room for a half hour waiting for propofol to wear off. The practice I do IT for and some other practices I have done IT for do colonosopies and EGDs. You sit in a bay with a curtain, no fancy room and no $500 fee. The whole procedure is a lot less expensive at a private ASC, usually. Our doctors and many doctors do work at ASCs and also see patients at the hospital. Usually the patients at the hospital are obese, on blood thinners, have heart disease or other complications, or their insurance will not go the inexpensive route and insist on paying the hospital more for the same work. Lots of imagining companies out there offering the same imaging services as the hospital at a lower cost.

By the way lots of hospitals have cash prices that are more reasonable than the advertised price. But I am IT, not procedure pricing so any comments I make may be way off. I do see the cash price posted in our billing department though for our ASC patients.

 

[dave1949]

I agree with many of your points. The one sticking point for me though in the approach you advocate is that medicine is not like having a kitchen remodel. You cannot realistically get a number of estimates and make an informed decision about which offers the best deal. Sure, you can shop around for an elective MRI and have it done at the least expensive location (MRIs are MRIs, essentially commodity items and if you wanted a different reading you could pay extra for that, zero reason for one setting to charge $500 and another to charge $5000). But you cannot shop around for emergency surgery and unless you live in a major metropolitan area, your ability to find enough physicians and hospitals in true competition with each other is very limited. It isn't really a free market out there. As such, there is a need for the sort of "collective bargaining" on your behalf that an insurer can do. That $5000 charge for a colonoscopy far far exceeds what it actually costs. If your insurer negotiated with the hospital to pay only $2500, you can be quite sure that the hospital still made a goodly profit. However, if you had, as an individual come to the hospital they would have more than likely stonewalled you and charged $5000 or maybe $4500. If they charged less they would run into trouble with their big insurance companies who have deals that say essentially that they will pay half of what the regular charge is. If the hospital let you pay $4000, the insurance company would want to pay only $2000 and that might squeeze the hospital profits.

Medicine is not a free market. We, as consumers, need the protection in that marketplace that only comes with either regulation or negotiating power. The regulatory strategy just ends up creating a static system for the doctors and hospitals to game. The large insurers on the other hand can be flexible but still wield considerable market clout and therefore benefit us. The down side of the insurance strategy is overhead. If you have one big insurer (eg Medicare) then the system supports one chunk of overhead/infrastructure to make things work. If there are 500 insurance companies, then the system needs to support much more overhead and that drives costs up as well as reducing the clout of each individual insurance company in the marketplace. That is why single payer is inherently more efficient.

We live in an area that is served by one hospital. Over the past several years they have consolidated group practices into a nice campus layout. They make extensive use of electronic records on a system that appears to be quite good. I have no complaints about the quality of the care delivered. They said they lost money last year.

I don't to mean sound anti-hospital. It matters a lot to the community that the hospital is there, attracts decent personnel, and delivers good quality of care. It is not to anyone's benefit that a large insurer squeezes the hospital out of business or into a poor standard of operation. Well, as we all know, it's complicated.

In May I will be on Medicare. Part B plus a supplemental policy including Part D will cost (me--not forgetting Part A) 40% of what I pay now for an individual policy. I will pay less for more coverage with lower deductibles. It will be a new adventure. Fortunately I don't need a doctor very often.

 

[ultrarunner]

The new clinics and Urgent Care Facilities in this area are all Physician owned. Some of the Docs are people my wife works with at the ER of a For-Profit Hospital. That hospital charges less money than the local not-for-profit sixty miles away. Many people drive sixty miles to save onethird to onehalf of cost for ER visit and proceedures.

Non Profit or Not for Profit are simply business models... many of which have come into scrutiny because of their high costs and profit margins.

I actually work for a For Profit which means we charge less than the two local Not for Profits... PLUS we get no tax breaks...

Medicine is so convoluted it will make your head spin...

The best at charity in my area were the Catholic Sisters and they have decades to back it up...

Under the new California ruling stating the Nuns must offer family planning services... the Nuns left California... the formerly well run Hospital has been hemorrhaging ever since to the point they announced pending closure... the Not for Profits had a come to Moses moment and each decided to chip in large cash infusions because they feared the uninsured would show up on their doorsteps.

One of the biggest Not For Profits recently sold an entire Hospital that had been earthquake retrofitted for $1 to the county... the reason... the Not For Profit had too many uninsured using the facility...

 

[MotorSeven]

Speaking as a physician performance analyst, I'd say you have a legitimate complaint about Dr #4 for probable incompetence and failure to perform. Write up you complaint, make sure you have the names and dates and account number of your visit, and send that to the hospital quality department AND the hospital CEO.

You'll get results, even though it may take 6 months.

I could, but a formal complaint has never entered my mind because I can make my own decisions based on that test with or without Dr #4's input. I know I should make a complaint to keep the next poor slob from getting the same treatment. But, I am more of a direct guy and would probably just call her or stop in next visit and give her my thoughts in an organized and rational tone. What she does with it after that is on her shoulders. You do bring up a good point, so I will kick it around with my numb feet:mischievous:.

 

[MotorSeven]

As far as the insurance debate/debacle, we ended up where we are because [we] as customers demanded full cost low deductible insurance plans. We should have never had insurance that pays for everything right down to your parking voucher. That was insane and the insurance companies should have said "NO", but instead they ran with it and the cost of coverage skyrocketed then piled up over the last couple of decades.

We should all re-think what we really need. Do I need the insurance company to pick up my Dr's office visit fee when I go in for a runny nose...nope. Should it cover trips to the ER room for things that a regular garden variety Dr could handle the next working day...nope. We are our own worst enemy. I want insurance for the "Big One" and I am more than willing to pay my own way if and when that happens. This is why I chose a policy that has $5K deductible for each of us and my insurance policy cost me a little over $300 a month. Those "Cover Everything Under the Sun" policies would cost us around $1K a month, so if you do the math for normal reasonable healthy people we over $8K a year. So I'm ok with taking the $5K deductible hit every few years...still ahead of the game:thumbsup:

Oh, and the side benefit of a big deductible is I become a informed educated "medical shopper"(sounds dangerous doesn't it???)..I ask questions about costs and necessity of procedures. It's already happened, in this long chain of Dr's, some have requested things like X-rays that a previous Dr already took...I say, "No, contact Dr Soanso, he already took them and have then sent over".