bmks270 said:

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Individual doctors are being put out by mega insurance and healthcare corps.

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This story plays out in lots of industries. The government is basically Lennie and small businesses are mice. As the administrative burden grows, only the largest companies can handle it or lobby on something like equal terms. It never looks like the government is doing it because the big companies are the more obvious presence, but megacorps and intrusive government regulators are symbiotic.


I'm pretty surprised that the private practice has lasted as long as it has.

Perfect timing. I heard the last 20 minutes of this podcast today. Listening to the beginning part now. It's almost a full hour, but I think it's worth listening to if you're truly interested in the issues with healthcare costs today. At least the last 20 minutes was, so far the first few minutes seem good as well.

https://www.npr.org/2020/09/02/908728981/slaying-the-fee-for-service-monster-of-american-healthcare

gotsand said:

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Same as it ever was except our family now functions under a high deductible plan, which essentially translates into 100% our responsibility for everything not maintenance related in most years. Although, we are more aware of the costs associated with medical care, they are in no way shape or form transparent. I do not think it is a sustainable model.

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Thiiiis. We are allllll paying more for less coverage. Thanks Obama.

There is no transparency and the insurance industry fights transparency tooth and nail. They know transparency will kill their margins.

Until employers are OUT of the picture as middlemen and insurers have to compete for customers the way home/auto providers compete, then the system remains broken and pricing opaque.

Combining a couple recent posts, it sound like we could describe the system this way:

The hospital's customer is insurance cos
Insurance's customer is an employer or the federal government
The employer or government pays a fixed fee for physical maintenance of its employees
The hospital is a subcontractor who performs the maintenance

The sick person isn't anyone's customer, the sick person is a machine undergoing maintenance. You don't ask a compressor if it understands the maintenance bill. This is why I don't think we'll ever really understand and own our bills and health until we become the customer.

The doctor is essentially a maintenance tech. I mean that as an analogy, not a pejorative, but it has become clear that in many cases the doctors are doing preventative maintenance and repairs while other parties control the business side.


I don't think that replacing insurance cos with government agencies is going to be a net good to the patient. It doesn't fix the root problem, it just throws lots of money around and tries to regulate away things that it doesn't like, but usually most of the consequences are unintended. And the patient is still paying the bill as a taxpayer.

Do you want to fix healthcare? Fix the barriers to reduce costs.

1. Make it almost impossible to Sue the doc. Needless testing and doctor visits will go down 75%
2. Don't hold docs accountable for patient satisfaction. Needless testing and doctor visits will go down 25%
3. Cut down on all the bureaucratic metrics, insurance maze, paperwork, gov regulations I have to jump over to take care of patients. Allow docs to own their own practice like the past and we can compete for patients.
4. Make the barrier low for docs to own their own business. See #4. Obamacare decimated physician practice. There is no way for a small doc group to open their own practice with all the government/insurance co hurdles.
5. Demand cash pay price for every test/procedure and let everyone compete. Get Rid of all the ICD10 codes for everything under the sun that allows for jacked up price. You want a knee replacement, you can use your insurance or pay the cash rate for the who comprehensive care. Prices will drop b/c many will see how much cheaper going cash pay is.
6. Require insurance companies pay providers in 30 dys, require they are in network, and get rid of the complicated mess of deductible, coinsurance, copayments, In vs out of network. Stop with the EOB which are meaningless. Stop with what the provider bills the insurance which are meaningless. Stop with all the payment denials and delay tactics. As a consumer why do I care that the doc billed 10K vs 1K when the provider is paid $500.
7. Let people pass away once their quality of life is poor. No reason to spend millions on dialysis for a nursing home pt who is laying in bed barely knowing what is happening around them just so Junior can collect SS checks.


Again, most doc would be a happy camper taking cash pay. If pts would pay me $100 per visit and take away the lawsuits/paper work requirements I would be happy getting paid what my HVAC guy charges just to show up to my house.

Imagine if no doctor accepted insurance. They all just sent their patients a bill, and the patient had to file the claim with insurance.

1) Reduced administrative costs - no medical billers, no fighting with insurance
2) Docs could just set their own price for services they provide. No worrying about also including every ICD 10 code possible when you really only need one or two to get fairly compensated and document what you actually did.
3) People would be the ones getting screwed over directly by insurance and actually demand change - or seek out a better/more customer friendly insurance company
4) People start paying cash because docs charge less/more transparently and insurance isn't worth the headache
5) ????
6) Profit for everyone once insurance starts having to fight for customers and have to stop screwing them over

Seriously, if insurance companies treated people the way they treat doctors, we'd see virtually bipartisan outrage and demand for change overnight.

texan12 said:

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Hanrahan said:

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Don't think so. We have been cash pay for a couple years and we always ask what is the price up front for an Office visit. Then at checkout we state we are cash pay and want to pay everything for the visit now that may have happened on top of office visit, given thy have no insurance to process and have the chart right in front of them that states everything done. We pay that price and then still get a bill later for other stuff, which I have begun wholesale ignoring After calling and telling them we asked to pay for everything up front and paid that price, which of course they never respond to, and so then have to ignore the collections agencies they eventually wind up at.

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Your credit didn't take a hit? I had an $80 bill which went to collections from a pointless repeated blood test I felt I shouldn't had to pay. Never had a bill go to collection so I gave in.

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It doesn't seem so. I believe we have 4-5 bills in collections, so we have to block a few new numbers here and there, but I've been ignoring them for quite a while now and haven't seen anything show up. My credit is like 825 so if we get something on there from it I would think I would readily see it reflect in a lower score. I don't really care, it isn't about the money I can easily pay them, I just refuse to on principle.

Medaggie said:

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Do you want to fix healthcare? Fix the barriers to reduce costs.

1. Make it almost impossible to Sue the doc. Needless testing and doctor visits will go down 75%
2. Don't hold docs accountable for patient satisfaction. Needless testing and doctor visits will go down 25%
3. Cut down on all the bureaucratic metrics, insurance maze, paperwork, gov regulations I have to jump over to take care of patients. Allow docs to own their own practice like the past and we can compete for patients.
4. Make the barrier low for docs to own their own business. See #4. Obamacare decimated physician practice. There is no way for a small doc group to open their own practice with all the government/insurance co hurdles.
5. Demand cash pay price for every test/procedure and let everyone compete. Get Rid of all the ICD10 codes for everything under the sun that allows for jacked up price. You want a knee replacement, you can use your insurance or pay the cash rate for the who comprehensive care. Prices will drop b/c many will see how much cheaper going cash pay is.
6. Require insurance companies pay providers in 30 dys, require they are in network, and get rid of the complicated mess of deductible, coinsurance, copayments, In vs out of network. Stop with the EOB which are meaningless. Stop with what the provider bills the insurance which are meaningless. Stop with all the payment denials and delay tactics. As a consumer why do I care that the doc billed 10K vs 1K when the provider is paid $500.
7. Let people pass away once their quality of life is poor. No reason to spend millions on dialysis for a nursing home pt who is laying in bed barely knowing what is happening around them just so Junior can collect SS checks.


Again, most doc would be a happy camper taking cash pay. If pts would pay me $100 per visit and take away the lawsuits/paper work requirements I would be happy getting paid what my HVAC guy charges just to show up to my house.

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The "impossible to sue the doctor" is such an overplayed card by doctors. We put controls on that in Texas and insurance rates didn't drop, doctors still kept ordering every test imaginable. Ambulance chasing lawyers definitely deserve part of the blame, hospitals and insurance companies essentially working with each other to jack rates up sky high deserve a huge part and, yes, doctors deserve part despite wanting to play the innocent card.

Medaggie said:

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All I say is I make my chart, and it gets billed out via standard Charges. I can send the same chart to 10 different insurance company and it will go like this.

UHC - Bills it at 2K, takes 6 months to pay and reimburses 300
BCBS - Bills it at $1500, takes 4 months and reimburses $550
Cigna - Bills it at $4K, takes 9 months and reimburses at $250
Medicaid - Bills it at 2K, takes 5 months and reimburses $50

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What are you talking about? Insurance companies do not "bill" different amounts. Your organization/practice sends the "billed" amount and each insurance pays it based on the contract your practice agreed to (outside of Medicare/Medicaid which dictates their own rates). Your practice has a chargemaster that has a charge (aka billed amount) for each and every CPT code.

Medaggie said:

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2. Don't hold docs accountable for patient satisfaction. Needless testing and doctor visits will go down 25%
7. Let people pass away once their quality of life is poor. No reason to spend millions on dialysis for a nursing home pt who is laying in bed barely knowing what is happening around them just so Junior can collect SS checks.

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2. You don't think you should be held accountable for the experience your patients receive while under your care? And how are you being held accountable? There are no payment incentives based on patient satisfaction. Press Ganey is completely voluntary and there is no nation wide patient satisfaction survey. Sounds like you are upset with your employer because they are holding you accountable for your scores.

7. I believe that is called a death panel or something along those lines. Who gets to decide when someone should be allowed to pass away? I am not actually opposed to this, but it is funny to rail against Obamacare, but then advocate for something everyone was afraid would happen under it.

Silky Johnston said:

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Medaggie said:

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2. Don't hold docs accountable for patient satisfaction. Needless testing and doctor visits will go down 25%
7. Let people pass away once their quality of life is poor. No reason to spend millions on dialysis for a nursing home pt who is laying in bed barely knowing what is happening around them just so Junior can collect SS checks.

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7. I believe that is called a death panel or something along those lines. Who gets to decide when someone should be allowed to pass away? I am not actually opposed to this, but it is funny to rail against Obamacare, but then advocate for something everyone was afraid would happen under it.

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I mean, call it a death panel if you want, but I think that's a bit of a misnomer. At the end of the day some people are essentially just a beating heart wrapped in skin. Their minds are gone, their muscles are gone, they feel pain from bed sores but they don't have the strength or the mental capacity to know they need to move to avoid them, they get infections because they can't eat or drink and end up aspirating food, so they go through a painful procedure to put a tube through the stomach wall directly into their stomach to feed them, they get urinary infections from being in diapers or having a urinary catheter in.

In all honesty, they should decide if they want to live like that before they get like that. But in instances when they don't is it ethical to allow them to be kept alive artificially so some kid or grandkid can keep collecting their SS check? If withdrawal of care allows a natural death to occur relatively painlessly and quickly, you could probably make the case that the panel should be called an "end suffering panel."

I also recommend watching "Extremis" on Netflix.

bigtruckguy3500 said:

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Silky Johnston said:

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Medaggie said:

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2. Don't hold docs accountable for patient satisfaction. Needless testing and doctor visits will go down 25%
7. Let people pass away once their quality of life is poor. No reason to spend millions on dialysis for a nursing home pt who is laying in bed barely knowing what is happening around them just so Junior can collect SS checks.

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7. I believe that is called a death panel or something along those lines. Who gets to decide when someone should be allowed to pass away? I am not actually opposed to this, but it is funny to rail against Obamacare, but then advocate for something everyone was afraid would happen under it.

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I mean, call it a death panel if you want, but I think that's a bit of a misnomer. At the end of the day some people are essentially just a beating heart wrapped in skin. Their minds are gone, their muscles are gone, they feel pain from bed sores but they don't have the strength or the mental capacity to know they need to move to avoid them, they get infections because they can't eat or drink and end up aspirating food, so they go through a painful procedure to put a tube through the stomach wall directly into their stomach to feed them, they get urinary infections from being in diapers or having a urinary catheter in.

In all honesty, they should decide if they want to live like that before they get like that. But in instances when they don't is it ethical to allow them to be kept alive artificially so some kid or grandkid can keep collecting their SS check? If withdrawal of care allows a natural death to occur relatively painlessly and quickly, you could probably make the case that the panel should be called an "end suffering panel."

I also recommend watching "Extremis" on Netflix.

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There is already a "death panel" in insurance companies. I know; my spouse is on it.

Your stats are called into the insurance and they determine if the days the hospital is requesting is correct or following the standard of care. If they aren't, the hospital has to eat the costs (or try to charge you). They can appeal to the insurance's doctors, but that's still a panel.

The doctor helping you most of the time is not the one, ultimately, making the decisions.

~egon

Dr. Doctor said:

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bigtruckguy3500 said:

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Silky Johnston said:

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Medaggie said:

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2. Don't hold docs accountable for patient satisfaction. Needless testing and doctor visits will go down 25%
7. Let people pass away once their quality of life is poor. No reason to spend millions on dialysis for a nursing home pt who is laying in bed barely knowing what is happening around them just so Junior can collect SS checks.

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7. I believe that is called a death panel or something along those lines. Who gets to decide when someone should be allowed to pass away? I am not actually opposed to this, but it is funny to rail against Obamacare, but then advocate for something everyone was afraid would happen under it.

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I mean, call it a death panel if you want, but I think that's a bit of a misnomer. At the end of the day some people are essentially just a beating heart wrapped in skin. Their minds are gone, their muscles are gone, they feel pain from bed sores but they don't have the strength or the mental capacity to know they need to move to avoid them, they get infections because they can't eat or drink and end up aspirating food, so they go through a painful procedure to put a tube through the stomach wall directly into their stomach to feed them, they get urinary infections from being in diapers or having a urinary catheter in.

In all honesty, they should decide if they want to live like that before they get like that. But in instances when they don't is it ethical to allow them to be kept alive artificially so some kid or grandkid can keep collecting their SS check? If withdrawal of care allows a natural death to occur relatively painlessly and quickly, you could probably make the case that the panel should be called an "end suffering panel."

I also recommend watching "Extremis" on Netflix.

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There is already a "death panel" in insurance companies. I know; my spouse is on it.

Your stats are called into the insurance and they determine if the days the hospital is requesting is correct or following the standard of care. If they aren't, the hospital has to eat the costs (or try to charge you). They can appeal to the insurance's doctors, but that's still a panel.

The doctor helping you most of the time is not the one, ultimately, making the decisions.

~egon

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It's a bit ****ed up, insurance companies refusing to pay, they aren't the doctors or the patients. They aren't holding up to their end of the bargain. They've got all of their algorithms, why don't we just apply those and cut out the doctors who have become the middle man between the patient and the insurance company.

This is a case of the tail wagging the dog.

Yeah, but they can't technically pull the plug. They just make hospitals and tax payers eat the costs when something happen how their algorithm says it should.

Also, if I'm not mistaken "death panels" were never going to happen under Obamacare, at least not how the media reported it and politicians used it.

What was supposed to happen was doctors were going to get paid more money to spend more time with patients to discuss end of life care so that there would be like an advanced directive, or consider hospice instead of futile efforts to prolong a low quality life, etc. Right now doctors tend to be reimbursed more for doing things (surgery, procedures, seeing more patients, stuff like that), and less money for their time when they spend an extra 20 or 30 minutes educating and discussing things with patients. It's unfortunate that we misrepresented it the way we did.

iluvpoker said:

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Cadet05 said:

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There will never be transparent pricing until all in network hospitals require all providers in the hospital to be in network. Nothing worse than going to an in network hospital and being treated by out of network providers when you don't have out of network coverage on your policy. It's not like you have a choiceOf who you are seen by once you get in the hospital. Better yet, put an end to the practice of back billiing!

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Yep. Having a doctor order tests and then finding out that provider isn't in- network needs to be corrected in the law. Also finding out that the company they sent the test results to have it analyzed isn't in-network needs to be changed by law.

When you take the trouble to make sure the doctor is in-Network then you expect everything including tests and analysis to be in-Network. If a doctor wants you to go get a pet scan and blood work done then they need to make sure they give you in-Network providers or disclose to you in writing that those are out of network providers.

My brother had stage 4 cancer last spring and the doc sent his blood work to SanFran for gene level testing. Turns out they weren't in network and sent my SIL a $20k bill. To make this worse my brother died before they ran the tests. The good news is they dropped their bill and the insurance covered the vastly reduced amount since by brother had already paid his max out of pocket for this year. But this should never have happened, yet it happens to unsuspecting people everyday.

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Veracyte - great testing but I know personally of a physician sending in testing without the patient knowing it while the company isn't covered in-network and therefore sending a $9000 bill. All without consent.

Sorry to hear about your brother ):

Yeah, I was wondering the same thing. I think part of the problem is that many physicians apparently don't understand how billing works in their own systems.

Ulrich said:

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YouBet said:

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Get rid of insurance and you probably fix this whole mess.

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Turn insurance into actual insurance instead of an intermediary in every transaction, no matter how insignificant.

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How do you do this though? It sounds great in theory, but the patient is not really equipped with the knowledge to know what procedures are needed. There isn't always a clear answer in medicine unlike fixing a car after a wreck. Say a doctor bills you for major services/procedures and insurance refuses to pay your claim? What then?

Generally, I'm a free market guy, but I'm about at the point of throwing in the towel and joining the realist camp. Healthcare administration has become so labyrinthine and premiums are so high that the current system is unsustainable for a majority of Americans. I think it is highly unlikely that politicians will find the spine to totally hit the reset button back to a free market approach (see: recent Republican majority in both houses + presidency).

12thAngryMan said:

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Ulrich said:

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YouBet said:

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Get rid of insurance and you probably fix this whole mess.

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Turn insurance into actual insurance instead of an intermediary in every transaction, no matter how insignificant.

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How do you do this though? It sounds great in theory, but the patient is not really equipped with the knowledge to know what procedures are needed. There isn't always a clear answer in medicine unlike fixing a car after a wreck. Say a doctor bills you for major services/procedures and insurance refuses to pay your claim? What then?

Generally, I'm a free market guy, but I'm about at the point of throwing in the towel and joining the realist camp. Healthcare administration has become so labyrinthine and premiums are so high that the current system is unsustainable for a majority of Americans. I think it is highly unlikely that politicians will find the spine to totally hit the reset button back to a free market approach (see: recent Republican majority in both houses + presidency).

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That's the thing though, once the patients start getting screwed over instead of doctors and hospitals, that's when we might actually see some meaningful action.

Although, to be honest, my hopes for long lasting meaningful action is slim. At the end of the day the insurance companies still control congress more than the voters.

Hit With An Unexpectedly High Medical Bill, Here's How A Savvy Patient Fought Back

https://www.npr.org/sections/health-shots/2020/10/27/926851809/hit-with-an-unexpectedly-high-medical-bill-heres-how-a-savvy-patient-fought-back?

Sorry for bumping an old thread, but this is something that really annoys me.