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What Happens When Doctors Only Take Cash (2017)

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Re: What Happens When Doctors Only Take Cash (2017)

#101

Post by javadocmd »

c3534l wrote: post #83
harrisreynolds wrote: post #46

I've been wondering for a while now why health insurance companies exist at all. They introduce a massive bureaucracy and massive costs and provide very little value. They evolved from a reasonable idea into a monster that just drains our system and do not provide enough value to justify their existence in my opinion.

> They introduce a massive bureaucracy and massive costs and provide very little value. I very much disagree. When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies. Insurance companies have a vested interest in reducing the costs of medical care, while doctors have a vested interest in increasing them. Screwing patients out of payments is not an aligned business mode…

> When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies.

You've identified the symptom but misattributed the cause. You ran afoul of the charge master system of billing, which is a byproduct of our insurance-based healthcare system and the laws which uphold it. In short, providers are "forced" to set their base rates high in the knowledge that insurance companies (their most significant revenue source) will negotiate a fraction of the posted rate. Meanwhile, federal law enforces (under very stiff penalty) that individuals cannot negotiate nor be given a discount from the base rate.

You are also correct to identify the inherent information imbalance in the doctor/patient economic exchange: you as the patient will never know for certain if the recommended course of treatment is appropriate. Realistically only a doctor has enough information to tackle that question. In a cash-based system you are indeed susceptible to abuses.

(In fact, this is one of the main arguments against concierge or "executive" medicine: they will frequently throw in wasteful and dangerous tests like full body scans which have absolutely no justification in medical science.)

But by the same token, insurance company incentives aren't aligned in your interest either, so there are even more abuses on that side.

I believe a single-payer system is the best compromise -- the government's incentives are best aligned to improve the health of the populace (securing a healthy workforce) at the least cost. ("Least cost?!", I can hear the scoffs as I type.) Only government systems have enough scope and lifetime to realize the long-horizon payoffs of preventive healthcare, and cannot so easily escape their failures (the way insurance companies could with lifetime caps). Many people are surprised to learn that Medicare is at least on par in terms of efficiency and above par in terms of patient outcomes and satisfaction.

Re: What Happens When Doctors Only Take Cash (2017)

#102

Post by Turing_Machine »

killjoywashere wrote: post #22
DoreenMichele wrote: post #16

Since their surgery center does not employ the army of administrators that is often required to haggle with insurers and follow up on Medicare reimbursements, their overhead is smaller. This is part of why Obamacare is fundamentally broken. Using the existing commercial insurance system to try to provide universal coverage injects unavoidable extra expense and complications. Really happy to hear about the trend the a…

This may work for chronic conditions and non-lethal problems, but creates a problem when you're talking about urgent care: stroke has a 2-3 hour window for administration of TPA. The goal for intervention in a myocardial infarction is under an hour, same for trauma, where people may be in the ICU for days to months (a lot of months). Who covers those costs?

Every insurance company in the United States, along with Medicare and Medicaid, already has a fixed amount that they will pay the caregiver for administration of TPA. I guarantee it, even without bothering to look up what TPA is. If the procedure is covered by insurance at all, there's a pre-approved reimbursement amount for doing it.

Outside of an expensive, time-consuming, and almost always useless appeals process, that flat rate is all the doctors are going to get. They can take it or leave it.

There are medical codes for every imaginable procedure, and essentially every medical code has a fixed, preset amount that the insurance company will pay to have it performed.

Re: What Happens When Doctors Only Take Cash (2017)

#103

Post by tomcam »

smachiz wrote: post #95
refurb wrote: post #70

Earlier quoted context omitted.

But it's no different with a car mechanic. The mechanic gives you a quote. If the costs changes they get your explicit approval. That would be nice to start there on the medical side.

Can't really do that in the middle of surgery...

It happened to me. I was in the middle of having half of my thyroid removed when my surgeon realized she had to remove the other half. She interrupted the surgery to call my wife and get permission even though she had already obtained it from me before I was put under.

Re: What Happens When Doctors Only Take Cash (2017)

#104

Post by rocketpastsix »

conanbatt wrote: post #85
will_brown wrote: post #61

Earlier quoted context omitted.

Odds are there is a State Law on point that requires a similar disclosure of estimates on medical services. Take Florida Statute 581.026, titled Florida Patient’s Bill of Rights and Responsibilities Subsection (4)(c)(5) reads: a health care provider or a health care facility shall, upon request, furnish a person, before the provision of medical services, a reasonable estimate of charges for such service. In one case…

Discharged unto whom, thats the question.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost.

Or pushed it onto tax payers somehow.

Re: What Happens When Doctors Only Take Cash (2017)

#105

Post by digi_owl »

rocketpastsix wrote: post #104
conanbatt wrote: post #85

Earlier quoted context omitted.

Discharged unto whom, thats the question.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

I recall encountering the claim that hospitals will mark up the initial bill because they are used to dealing with insurance companies, and said companies will turn over very stone possible to drive the price down. Thus the markup is done to ensure the hospital get their expenses covered after the insurance companies are done with them.

Re: What Happens When Doctors Only Take Cash (2017)

#106

Post by paulmd »

conanbatt wrote: post #63
Giacomot wrote: post #29

Earlier quoted context omitted.

Free healthcare is a great incentive to be careless with your body. /s* edit: I was being sarcastic

Free healthcare is a great incentive for the state to ban alcohol, sugar and drugs. Not /s if you look at actual argumentation on soda taxes.

Ironically, the obese tend to have low overall healthcare spending. You die early and spare them the extreme levels of spending that typically occur during care of the elderly.

Re: What Happens When Doctors Only Take Cash (2017)

#107

Post by conanbatt »

rocketpastsix wrote: post #104
conanbatt wrote: post #85

Earlier quoted context omitted.

Discharged unto whom, thats the question.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

> ate the cost.

If they ate the cost, someone else paid for it. Which means that prices in general take this into account. I'm not judging OP, but saying that the ability to apply that technique is not= the solution to the general problem. (Healthcare is expensive).

Re: What Happens When Doctors Only Take Cash (2017)

#108

Post by javadocmd »

noobhacker wrote: post #84
conanbatt wrote: post #62

Earlier quoted context omitted.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

The high health care cost is due to a lot of unnecessary procedures being performed. This can happen in two ways. First, there are a lot of tests and procedures ordered by doctors that only have some, but very small, benefits for the patients [0]. Doctors are incentivized to do this because each procedure has a set price (negotiated with insurance companies and Medicare / Medicaid) and the only way to get more revenu…

Insurance (including Medicare and Medicaid) can and do push back against things they identify as inappropriate treatment. There are many problems with this system -- too restrictive in some places, not restrictive enough in others -- but in theory this could be improved to act as a reasonable check on rogue doctors.

Another relevant effect worth noting here is CYA medicine: doctors order tests aimed at catching highly unlikely conditions to protect themselves against the hypothetical lawsuit that asks "why didn't you test for that?" Whatever the truth is about malpractice suits, the perception in the industry seems to be that these cases are overwhelmingly biased against doctors if even one question can be raised about the course of treatment.

Re: What Happens When Doctors Only Take Cash (2017)

#109

Post by killjoywashere »

Turing_Machine wrote: post #102
killjoywashere wrote: post #22

Earlier quoted context omitted.

This may work for chronic conditions and non-lethal problems, but creates a problem when you're talking about urgent care: stroke has a 2-3 hour window for administration of TPA. The goal for intervention in a myocardial infarction is under an hour, same for trauma, where people may be in the ICU for days to months (a lot of months). Who covers those costs?

Every insurance company in the United States, along with Medicare and Medicaid, already has a fixed amount that they will pay the caregiver for administration of TPA. I guarantee it, even without bothering to look up what TPA is. If the procedure is covered by insurance at all , there's a pre-approved reimbursement amount for doing it. Outside of an expensive, time-consuming, and almost always useless appeals process…

I get that. Do you know the history of the CMS billing schedules? They called Dr. DeBakey and he sent a couple of his fellows to Washinton and they priced out every single thing. That has been revised, amended, and addended many times since, but yes, I'm well aware.

The point is that there's no shopping around in the emergent cases. You can't say "Well, in my incapacitated, mid-stroke state, let me check the menu of the 3 nearest hospitals for the cost of a stroke admission." It ranges from "nothing to do here, looks like it was a TIA, patient demands to go home" to "We need to take your wife to the OR for an emergent craniotomy and clot removal to decompress the foramen of Monroe. Right now. Because minutes are brain cells."

Re: What Happens When Doctors Only Take Cash (2017)

#110

Post by verbatim »

conanbatt wrote: post #107
rocketpastsix wrote: post #104

Earlier quoted context omitted.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

> ate the cost. If they ate the cost, someone else paid for it. Which means that prices in general take this into account. I'm not judging OP, but saying that the ability to apply that technique is not= the solution to the general problem. (Healthcare is expensive).

Your assumption that "someone else paid for it" only holds if the price was directly tied to external costs and not their own profit.
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