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Why doctors pay millions in fees that could be spent on care

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Re: Why doctors pay millions in fees that could be spent on care

#31

Post by scythe »

hedora wrote: post #25

The last time I checked, 33% of US healthcare dollars went to paying people at the insurance company and people at the healthcare provider to negotiate with each other. One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party…

>As every other first-world country has done at this point.

This is simply not true, and there is another option that deserves to at least be mentioned:

http://en.wikipedia.org/wiki/All-payer_rate_setting

Re: Why doctors pay millions in fees that could be spent on care

#32

Post by lotsofpulp »

codegeek wrote: post #22
Vvector wrote: post #20

Earlier quoted context omitted.

Imagine if we had "food insurance". Your grocery store is "in network", but the butcher sends you a bill because he is out-of-network. No prices on anything, because your insurance carrier has "negotiated" a price for you, which you only find out after the fact.

Or imagine you had Car Insurance butting in everything including an Oil change and dictating which shop you can use for the oil change. I bet it won't be a $20-$30 oil change anymore and your premiums will be much higher than it already is. Btw, don't give the Food industry these ideas :). It would suck if we now have "Food Insurance"

That exists, they are called high deductible plans, and people still complain about the high deductibles.

The root problem is the tail end of healthcare is enormously expensive, into the millions of dollars. Insuring a car is a minor expense, max $50k for the vast majority. It is the healthcare, that could require years of therapy and work done by extremely highly qualified people in short supply, using patented medicines, all wrapped up in liability protection, because if someone makes a mistake, you are eligible for up to millions of dollars in damages.

And also, if you are under age 50 and/or healthy, you are not just paying to insure your health in this calendar year, you are paying for healthcare older and/or sicker people are receiving. Health insurance premiums are more similar to a tax than an insurance premium.

Re: Why doctors pay millions in fees that could be spent on care

#33

Post by TuringNYC »

no_wizard wrote: post #21

Medical Billing is ripe for disruption, but of note, I don't know of any startup that has made significant inroads into this market. Anyone know why its so tough to break?

>> I don't know of any startup that has made significant inroads into this market. Anyone know why its so tough to break?

Because multiple parties in the system are both making money and control the standards of practice. This makes real competition incredibly difficult.

Re: Why doctors pay millions in fees that could be spent on care

#34

Post by jewayne »

hedora wrote: post #25

The last time I checked, 33% of US healthcare dollars went to paying people at the insurance company and people at the healthcare provider to negotiate with each other. One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party…

Not every first world country has a true single-payer healthcare system. There are many variations that work better than what we have. The difference is that in the US we have accepted profit maximization as the legitimate primary goal in the healthcare system.

Re: Why doctors pay millions in fees that could be spent on care

#35

Post by zeruch »

no_wizard wrote: post #21

Medical Billing is ripe for disruption, but of note, I don't know of any startup that has made significant inroads into this market. Anyone know why its so tough to break?

Complexity across providers and regulatory compliance are my most likely guesses.

Re: Why doctors pay millions in fees that could be spent on care

#36

Post by bombcar »

koolba wrote: post #10

> Many insurers, after whittling down physicians' reimbursements, now take an additional cut if the doctor prefers — as almost all do — to receive funds electronically rather than via a paper check. What’s the angle here? Classic rent seeking because they can? Profiteering collecting interest on the float? Banking on doctors being slow to cash physical checks? There’s some heavy stickiness to using one of these paper…

It's doubly strange because usually it's the other way around; if you want the paper check you have to pay for it, otherwise they transfer (slowly) electronically. Some places have a "pay you before" option that is electronic and fast and also takes a fee.

Re: Why doctors pay millions in fees that could be spent on care

#37

Post by bombcar »

codegeek wrote: post #22
Vvector wrote: post #20

Earlier quoted context omitted.

Imagine if we had "food insurance". Your grocery store is "in network", but the butcher sends you a bill because he is out-of-network. No prices on anything, because your insurance carrier has "negotiated" a price for you, which you only find out after the fact.

Or imagine you had Car Insurance butting in everything including an Oil change and dictating which shop you can use for the oil change. I bet it won't be a $20-$30 oil change anymore and your premiums will be much higher than it already is. Btw, don't give the Food industry these ideas :). It would suck if we now have "Food Insurance"

"Food Insurance" does exist in some places and cases; many colleges charge for "room and board" if you live on-campus, so you're paying for meals even if you don't eat them that day, or at all.

Re: Why doctors pay millions in fees that could be spent on care

#38

Post by anonuser123456 »

hedora wrote: post #25

The last time I checked, 33% of US healthcare dollars went to paying people at the insurance company and people at the healthcare provider to negotiate with each other. One way to avoid this in the US is to go with an HMO, since they can be wildly profitable and still be much more efficient than an insurance company + independent providers. Of course, the problem with that is that non-emergency care from third-party…

>A better way to solve the problem is to go with a single-payer healthcare system

Better for who, and under what circumstances?

Re: Why doctors pay millions in fees that could be spent on care

#39

Post by [deleted] »

bombcar wrote: post #37
codegeek wrote: post #22

Earlier quoted context omitted.

Or imagine you had Car Insurance butting in everything including an Oil change and dictating which shop you can use for the oil change. I bet it won't be a $20-$30 oil change anymore and your premiums will be much higher than it already is. Btw, don't give the Food industry these ideas :). It would suck if we now have "Food Insurance"

"Food Insurance" does exist in some places and cases; many colleges charge for "room and board" if you live on-campus, so you're paying for meals even if you don't eat them that day, or at all.

[deleted]

Re: Why doctors pay millions in fees that could be spent on care

#40

Post by pc86 »

no_wizard wrote: post #21

Medical Billing is ripe for disruption, but of note, I don't know of any startup that has made significant inroads into this market. Anyone know why its so tough to break?

1. Good luck finding a startup, especially a VC-backed one (which for this kind of market I would expect is a borderline necessity), that isn't going to charge at least this much if not more per transaction.

2. Would their customer be the insurer or the doctor? If it's the doctor, I can't see insurers wanting to reimburse anyone other than the doctor. If it's the insurer, why would they farm out their billing to this third party when they already have the capability, and it's clearly lucrative?

3. Medicine in general is ripe for disruption, but it's so heavily regulated that eats into a lot of the potential profits from any service provider. Everything is an enterprise contract negotiation and the technical talent leaves pretty quickly when they see how slow everything moves. I've worked with large hospital systems that were still running Windows 7. Recently.

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