ERs are hiring fewer doctors to save money • Hacker News Board

Re: ERs are hiring fewer doctors to save money

#91

Post by adam_arthur » Mon, Feb 13, 2023, 6:47 PM UTC

antisthenes wrote: post #90

adam_arthur wrote: post #16

Earlier quoted context omitted.

Most hospitals are already losing money or close to losing money. Taking away profit motive from them e.g. by subsidizing operation would only increase cost of care, because the incentive to run lean/efficiently goes away. The insurance system and perverse incentives embedded in it is the primary reason healthcare is expensive here. Also many countries have price controls on drugs, and US does not (thus subsidizing R…

> Most hospitals are already losing money or close to losing money. Taking away profit motive from them e.g. by subsidizing operation would only increase cost of care, because the incentive to run lean/efficiently goes away. This comes up in every thread about healthcare and it's just plain wrong/backwards. The reason they appear to be losing money or close to losing money is by design, because of the incentive to be…

If you look at Hospital REITs, the majority of the systems have low rent coverage on a cash flow basis. Look at the distribution yields/low multiples applied to hospital real estate... many are priced with high tenant default/bankruptcy risk.

e.g. MPW

Hospitals are not the same as Medical Office, which tend to be more profitable. Where are the facts to corroborate your statement?

Re: ERs are hiring fewer doctors to save money

#92

Post by klyrs » Mon, Feb 13, 2023, 6:57 PM UTC

cptcobalt wrote: post #87

klyrs wrote: post #69

Earlier quoted context omitted.

I'm not sure about that. Private health care is largely beneficial in countries with strong socialized health care. I'm definitely no expert on financial regulation, but I see the practice of "flipping" businesses as the real problem. Where I live, we've recently introduced a "house flipping tax" (which doesn't go far enough, in my opinion, but that's another conversation). A similar approach could be taken to privat…

Yeah, private healthcare can always be a valid addition, but access to "strong socialized healthcare" should be a relatively good minimum floor — something many countries do not have. All humans need health maintenance, it doesn't need to be a "can I afford it" value proposition. I know friends currently living without it because they can't , even with subsidized social options... this is endemic to the problem of "s…

Absolutely. The US creates particularly perverse incentives. In countries with strong socialized healthcare, private offerings must be better than the public service to be worthwhile. In the US, private healthcare needs to be better than literally nothing when a big player buys up the competition.

Re: ERs are hiring fewer doctors to save money

#93

Post by bluesquared » Mon, Feb 13, 2023, 7:42 PM UTC

ourmandave wrote: post #14

My last ER visit I was seen by a PA, which is fine. They're more than competent. The part I didn't like was how they made me get out a credit card while they we're treating me. Which, according to a story by the NY Times, is a common thing. Send a nurse around with a swipeable tablet to ask how you'd like to pay. https://www.nytimes.com/2023/01/25/podcasts/the-daily/nonpro...

I was having a minor anaphylactic reaction to something - not enough to restrict my breathing or make me want to use my epipen yet - but I experienced the same thing. Went to the ER, face red and swelling, lips starting to tingle, the whole 9 yards. They had me enter all my personal info, name, address, insurance card, etc. Then swipe for my $250 ER copay all before seeing anybody competent. The worker at the desk didn't understand what I meant when I said "anaphylactic reaction" I had to gesture at my face and say "allergic reaction" ffs!

At least my reaction wasn't as bad the first time. That time was pre-covid and they had somebody with experience and functioning brain cells at the check-in and they brought me right in and started taking vitals and did an IV literally right on the other side of the check-in desk. On that visit they had the payment person come around hours later while I was recovering in a bed on a different unit for monitoring while I was coming down off of the meds they pumped me full of.

Re: ERs are hiring fewer doctors to save money

#94

Post by snacktaster » Mon, Feb 13, 2023, 8:23 PM UTC

azinman2 wrote: post #23

klyrs wrote: post #17

> Private equity companies pool money from wealthy investors to buy their way into various industries, often slashing spending and seeking to flip businesses in three to seven years. The focus of the article is on physicians vs. NPs and PAs, but the real driver of the enshittification is, yet again, private equity firms extracting short-term profits, to hell with long-term outcomes.

We need to outlaw for profit anything with healthcare. The incentives are misaligned with society’s needs.

Boy you people really love banning things don't you. Why on earth would you _outlaw_ people from being able to see their private, for-profit family doctor.

Re: ERs are hiring fewer doctors to save money

#95

Post by mikeyouse » Mon, Feb 13, 2023, 8:27 PM UTC

oaktrout wrote: post #85

mikeyouse wrote: post #57

Earlier quoted context omitted.

The AMA probably isn't the best source for that type of data. The little throwaway lines in that review are funny; "Patients deserve care led by physicians—the most highly educated, trained and skilled health care professionals. Through research, advocacy and education, the AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety." Weird because the study they'…

The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to…

Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite;

"Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medicalcare/Fulltext/2021/02000...

"Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care." - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559935/

For a few examples from the past couple years.

Re: ERs are hiring fewer doctors to save money

#96

Post by wyldfire » Mon, Feb 13, 2023, 9:27 PM UTC

ketzo wrote: post #19

shiftpgdn wrote: post #5

Earlier quoted context omitted.

Counterpoint: You can go read the “Noctor” subreddit or ask any practicing physician why it’s bad for patient outcome. Ultimately we need more doctors and less hospital administrators.

Man, that subreddit reads like the most massive case of sour grapes imaginable. It's just people (presumably a lot of physicians / med students?) griping about how NPs and PAs are acting too good for their titles. All the actual stories are, like, one-off anecdotes about how some NP made some medical mistake. As if MDs don't make a massive amount of mistakes, I guess? Edit: lol, reading more, and I have seen multiple…

They covered that one already:

https://www.reddit.com/r/Noctor/comments/yf3ajr/updated_fpa_...

> Arguments Not Allowed

...

> Doctors make mistakes too. Yes, they do. Why should someone with less training be allowed to practice independently? Discussions on quality of mistake comparisons will be allowed.

Re: ERs are hiring fewer doctors to save money

#97

Post by seattle_spring » Mon, Feb 13, 2023, 9:37 PM UTC

mikeyouse wrote: post #95

oaktrout wrote: post #85

Earlier quoted context omitted.

The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to…

Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite; "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medical…

It is a bit rash, but it’s the exact same study trotted out literally thousands of times by disgruntled residents on Reddit, fuming that there exists a profession that can practice medicine without years of humiliating residency. Whenever someone uses that study as a citation, it’s immediate reason to discredit anything else they’re going to say. Just spend a few minutes looking at that “Noctor” subreddit the guy shared. It makes me disguised with MDs in general just reading it, until I remind myself that most of the posters there are just inexperienced students or residents. I do feel bad for the suckers that take its content at face value though.

Re: ERs are hiring fewer doctors to save money

#98

Post by oaktrout » Mon, Feb 13, 2023, 9:49 PM UTC

mikeyouse wrote: post #95

oaktrout wrote: post #85

Earlier quoted context omitted.

The AMA obviously has an agenda, but that doesn't that change the fact that non-physicians cost patients and taxpayers more money, hard to argue with the cms data. Who cares if your doctor gets paid more if he is saving you and the taxpayers money. I guess it might make business sense from a hospital perspective, because physicians are more expensive to employee than NPs and hospitals don't have a business reason to…

Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite; "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medical…

Truly it's a nuanced topic and you cannot say that across the board NPs cost more than physicians. I have no doubt that NPs and PAs can be cost saving when employed appropriately.

An issue with your first study is that some NP care was attributed to physicians (as a result of NPs billing under a physicians NPI), hence decision making that was done by an NP is being analyzed as if it was done by a physician. In the study I linked that wasn't have been an issue as they could see which patients were on which providers panel.

The study you linked on PAs is interesting, although it's an international one and ~24% of included studies were of PAs who did only one procedure (not really applicable to the discussion here). If you bring a PA into your practice to do only one procedure it's hard to envision that being much of an issue.

The NPR article itself links to a study that shows NPs cost more than physicians (in the emergency department), so it's not just one random study that shows they can cost more.

I think we could both post studies back and forth all day, maybe it makes more sense to look at things from first principles. If your ED visit is billed the same whether you are seen by an MD or NP, how would an NP go about saving you money? I hope that we can agree they will have less medical knowledge, so I don't see how they could order fewer studies / tests safely.

Re: ERs are hiring fewer doctors to save money

#99

Post by oaktrout » Mon, Feb 13, 2023, 9:51 PM UTC

seattle_spring wrote: post #97

mikeyouse wrote: post #95

Earlier quoted context omitted.

Claiming as a fact that non-physicians cost more money based on the back of one random study from a Mississippi health system might be a bit rash. Especially since almost every other bit of research has shown the opposite; "Overall, the average PCMD cost of care is 34% higher than PCNP care in the low-risk stratum, and 28% and 21% higher in the medium-risk and high-risk stratum" - https://journals.lww.com/lww-medical…

It is a bit rash, but it’s the exact same study trotted out literally thousands of times by disgruntled residents on Reddit, fuming that there exists a profession that can practice medicine without years of humiliating residency. Whenever someone uses that study as a citation, it’s immediate reason to discredit anything else they’re going to say. Just spend a few minutes looking at that “Noctor” subreddit the guy sha…

Truly reddit is a place full of idiots on all sides, do you have specific criticisms of the study I posted though? Or specific criticisms of the study in the NPR article?

Re: ERs are hiring fewer doctors to save money

#100

Post by 908B64B197 » Mon, Feb 13, 2023, 10:05 PM UTC

oaktrout wrote: post #22

themitigating wrote: post #9

Earlier quoted context omitted.

Doctors say we need more of them and their high pay?

I'm sure the high paid software engineers at boeing said something similar when jobs were being outsourced "we need more US engineers". Look at the software problems they had and tell me they were wrong. Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong.

> Just like software engineers are best qualified to evaluate software quality, doctors know medicine better than anyone else. Just because they are incentivized to protect their job doesn't mean they are wrong.

It was rather trivial for Boeing engineers to show, without a doubt, that the cheap offshored programmers didn't write software as good as they did. The design simply spoke for itself and didn't perform to spec.

Why not simply have doctors do the same? If their fellow medical workers can't deliver the same quality of care at the same speed and cost, then it should be trivial to show.