Health care - administrative incompetence

[Uncayimmy]

But the flaw in your theory is the part about negotiating better rates - it is very difficult to get higher rates. It is impossible if you are located near a city. The insurance companies refuse to give you higher rates. They don't care if you participate with them or not because the doctor next door does. You have zero negotiating power.

Are you telling me that the rates haven't increased at all in the last 20 years?

 

[Rolfe]

Much of the debt is owed to private institutions who paid professors and incurred other costs associated with education. The government has no business forcing them to 'write off' what is rightfully owed to them.

You misunderstand. Pay the debt for them.

That's more or less how Bevan got the British doctors onside, and a stuffy snobbish bunch they were too. "I stuffed their mouths with gold."

There are lawyers (hundreds of thousands of them) policing this. God help you if you hang a sign out and are not qualified.

I'm not talking "qualified", I'm talking "practising the most effective, modern, evidence-based medicine." Do you even know what medical audit is?

I do understand my future is in question - to a degree anyway. I'd just as soon retire or go do something else anyway. The liklihood of one of 'my' physicians or facilities getting audited looms larger every year. It would render me broke to defend a governmental lawsuit I'd most certainly be dragged into.

The people it will suck to be when the revolution comes, are the armies of ordinary people working to ease or block the flow of money around the present system. It's hardly their fault they're in the position they are, but they're parasites.

The question is, since Medicare is basically socialized medicine for people aged 65 and up, how can you say a totally socialized system would work? Medicare is broke. In 17 years when I turn 65 it will not exist. The U.S. government is incapable of running healthcare - or Medicare would not be in the condition it is in now.

I'm not an expert, but if you set up a healthcare system precisely to look after only the segment of the population most likely to require large amounts of expensive healthcare, then it's going to be difficult to fund. Get the healthy well-off people in, and it starts to look better.

I'm told that Medicare was doing OK till Dubya tool a hammer to it, but I'll let others present the details. If there's any reason the US government, as a general entity, can't run social programmes well, it seems to me to lie in the ingrained antipathy to anything it sees as "socialism", and a consequent tendency to destroy it so it can say "I told you so".

Sucks to be American.

Rolfe.

 

[bookitty]

But the flaw in your theory is the part about negotiating better rates - it is very difficult to get higher rates. It is impossible if you are located near a city. The insurance companies refuse to give you higher rates. They don't care if you participate with them or not because the doctor next door does. You have zero negotiating power.

So a universal system wouldn't pay doctors enough but our current free market system...doesn't pay doctors enough?

 

[Rolfe]

No. The physicians would have their own billing employees if they did not employ us. The fact is we do it better for far less than what they would pay (or did pay) their own billing department(s).

You, someone else, it's all overhead that simply doesn't exist in a universal system like the NHS.

GPs are paid a set amount per patient on their list, and extra for meeting targets like immunisation and screening tests carried out, and extra is they're in a deprived area to try to even out social inequalities.

They're self-employed, technically, although there are all the incentives and standards that have to be met. They have to manage their budget, but they don't have to itemise what's spent on any particular patient, or bill anyone in that respect.

Imagine it!

Rolfe.

 

[Rolfe]

<snip>

Patients do not pay for a more expensive service because the insurance companies set their reimbursement rates. The physicians have no choice in the matter except to not participate with a given insurance company. Like I explained earlier, the physician can charge whatever s/he wants but the insurance company will pay its pre-determined allowed amount.

Insurance companies do not hire people to fight us. We fight their denials, they do not fight us. Not sure what you mean by this.

-P

You're taking money out of the system, which has to come from somewhere. As are all the people the insurance companies are paying to do the denying part.

Rolfe.

 

[Ampulla of Vater]

Are you telling me that the rates haven't increased at all in the last 20 years?

This is not so easy to answer.

Medicare has a very complicated methodology to determining payments. The overall answer is no, although the cost of living adjustor might have gone up by a few tenths - I am looking at this now.

Private insurers have reduced payments over the past 20 years, guaranteed.

Mostly what happens is:
1) The codes change so the physicians end up with less reimbursement per service but it is not direct. For example, until 2010 a physician could charge for a consultation if another physician requested a specialist. Effective 1/1/10 those codes were abolished. This resulted in a serious reduction in payments for all specialists.

2) Coverage changes: for example you used to get paid 80% from Medicare and 20% from Blue Cross. Then Blue Cross changed their policy to only pay 80% of the 20% which left the physicians billing patients for $1.80. It isn't worth sending a bill for $1.80 so docs just wrote it off. Result=reduction in pay.

 

[Garrison0fMars]

The question is, since Medicare is basically socialized medicine for people aged 65 and up, how can you say a totally socialized system would work? Medicare is broke. In 17 years when I turn 65 it will not exist. The U.S. government is incapable of running healthcare - or Medicare would not be in the condition it is in now.

Medicare isn't "socialized medicine". It is "socialized financing", but it's not like the NHS system, most providers are private who take Medicare.

Also, source that Medicare is "Broke"? The US government doesn't need to "run healthcare", it can simply "finance" healthcare, like Medicare.

 

[Ampulla of Vater]

So a universal system wouldn't pay doctors enough but our current free market system...doesn't pay doctors enough?

Correct. But our current "free" market system pays them more than a universal system would, if Medicare and Medicaid are anything to go by.

 

[Garrison0fMars]

Correct. But our current "free" market system pays them more than a universal system would, if Medicare and Medicaid are anything to go by.

You're right, if you're referring to select specialists. Primary care physicians and other less glamorous specialties have taken a big hit by the private insurance industry.

 

[Rolfe]

If they didn't deny the claim (or lose it) in the first place they wouldn't have to communicate with us at all.

The insurance companies probably spend more money trying not to pay the claim than they would by just paying the stupid thing. They have strict timely filing limitations so if you submit a claim and find out they "just don't have it" but it is 60 days after the service was rendered, you are s.o.l. as you cannot get payment now. And no, you cannot bill the patient either. Think of how much money they are saving with all the physicians who do not have vigilant billing staff and let these time frames lapse.

Much of what we do is also for the patient's benefit - it is easier to get the money from the insurance company than it is to get it from the patient. We are customer service oriented. We want the patients to be happy with us so we spend the majority of our time being the middleman between the patient and their insurance company and leaning on the insurance company to pay.

Yes, of course you're on the side of the patients. But you're still an unnecessary overhead. You contribute nothing to actual patient care. You, and the people you correspond with, are equally parasites.

When there is no dispute that a patient is entitled to what their doctor agreed they should have, and the doctor is simply funded by a lump sum to look after the patients on his list, the whole thing just goes away.

Rolfe.

 

[Rolfe]

You're right, if you're referring to select specialists. Primary care physicians and other less glamorous specialties have taken a big hit by the private insurance industry.

I'm not even sure about the select specialists, if you do the sums right. Senior consultants have more money than God, especially the ones with significant private practices as well as their NHS work.

Their overheads are much lower than US overheads, and they don't have to pay for their own healthcare coverage!

Rolfe.

 

[bookitty]

Correct. But our current "free" market system pays them more than a universal system would, if Medicare and Medicaid are anything to go by.

I haven't seen any evidence of that. The age discrepancy and associated costs are too dramatic to make an across the board comparison.

The savings in administrative costs, such as jobs like yours, combined with a pool of younger healthier people to balance things out, could well make up the difference.

 

[Ampulla of Vater]

Medicare isn't "socialized medicine". It is "socialized financing", but it's not like the NHS system, most providers are private who take Medicare.

Also, source that Medicare is "Broke"? The US government doesn't need to "run healthcare", it can simply "finance" healthcare, like Medicare.

http://moneywatch.bnet.com/saving-money/blog/devil-details/could-you-die-faster-medicares-broke/290/

http://www.washingtonpost.com/wp-dyn/content/article/2006/05/01/AR2006050101448.html

http://seniorjournal.com/NEWS/Medicare/2008/8-03-26-NewTrusteesReport.htm

 

[Ampulla of Vater]

Yes, of course you're on the side of the patients. But you're still an unnecessary overhead. You contribute nothing to actual patient care. You, and the people you correspond with, are equally parasites.
When there is no dispute that a patient is entitled to what their doctor agreed they should have, and the doctor is simply funded by a lump sum to look after the patients on his list, the whole thing just goes away.

Rolfe.

Geez Rolfe. Don't parse any words on my account.

 

[Garrison0fMars]

Here's something I found interesting

"A beloved physician is fired for devoting too much time to his patients"

Randt and his practice partner were fired in April because of lack of productivity, he was told. (Randt's former partner asked not to be identified for this story.) He was also told that the local economy — the comfortably middle-class suburbs of Cleveland's West Side — could not support the existing number of primary care physicians.

"I'm devastated. I really do not know where we are going to go," says Bay Village resident Bonny James. "I don't want to go somewhere where the doctor has their hand on the doorknob and you're still sitting on the table saying, 'Yes, but...'"

 

[Rolfe]

Geez Rolfe. Don't parse any words on my account.

I'm a vet. I speak technically.

Rolfe.

 

[Garrison0fMars]

I'm not even sure about the select specialists, if you do the sums right. Senior consultants have more money than God, especially the ones with significant private practices as well as their NHS work.

Their overheads are much lower than US overheads, and they don't have to pay for their own healthcare coverage!

Rolfe.

Here's more.

“I’m just trying to get through the rest of the day,” he said as his voice broke.

Randt said his termination underscores a larger problem in medicine — the inadequate compensation primary care physicians are given by insurance companies compared to medical specialists.

Randt told protesters that primary care physicians need to spend an adequate amount of time with each patient because taking an adequate patient history is 70 to 80 percent of making an adequate diagnosis.

 

[xjx388]

In the case of adult diapers, Medicare covers something like 96% of seniors [ETA]. Seems to me like they are the biggest target. Can you please try to keep multiple concepts in your head at once? This is very annoying.

So, are you arguing that fraud doesn't exist in the private sector? Have you forgotten that private insurance companies are repeatedly sued by individuals just to get them to pay a claim? Have you forgotten that with just one rescission for a patient like Ducky they can more than cover the $1M fraud in adult diapers? Those rescissions don't make the papers, but diaper fraud does.

<still shaking head>

BZZZZZT! Incorrect but nice try.

The reason fraud and abuse almost never happens is because of one simple mechanism: cost-sharing. In Medicare/Medicaid the patients don't pay a red cent.

 

[Rolfe]

I'm pretty sure they do.

In contrast to the NHS, where patients actually don't pay a brown penny.

And in which fraud appears to be entirely confined to the staff.

Rolfe.

 

[Garrison0fMars]

BZZZZZT! Incorrect but nice try.

The reason fraud and abuse almost never happens is because of one simple mechanism: cost-sharing. In Medicare/Medicaid the patients don't pay a red cent.

Wrong, AGAIN! Medicare has co pays, AND premiums. Some on Medicaid pay nothing (they're on what's called "no cost" medicaid), but others have cost sharing (co pays). Someone I know who's married has a 600 USD pay difference with her Medicaid coverage.