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Medical equipment pricing is completely broken when a sling costs $200

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Re: Medical equipment pricing is completely broken when a sling costs $200

#281

Post by repiret »

jimmaswell wrote: post #236
repiret wrote: post #106

Earlier quoted context omitted.

They’re not shell organizations, hospitals just outsource tons of stuff, frequently including physicians. (In fact, in California, hospitals may not legally employ physicians to practice medicine)

>in California, hospitals may not legally employ physicians to practice medicine ...why?

The sort answer is California Business and Professions Code 2417.5, but thats probably not exactly what you meant.

Most (all?) states forbid whats called the "Corporate Practice of Medicine." The idea is that profit motive of a corporation can lead the corporation to manage physicians contrary to the interests of their patients. To mitigate this, states only allow certain business models for physicians:

* Sole Proprietorships - they can work for them selves

* Professional Corporations - a restricted sort of corporation that requires all shareholders and executives to hold a license for the profession the corporation practices (ie, they all must be physicians)

* Some states have exceptions for research universities, public hospitals, non-profits, and other sorts of organizations.

The exact restrictions of course vary from state to state. Here's a state-by-state rundown: [1]

Its my understanding that analogous restrictions are common for other licensed professions such as law and accounting, but I know much less there.

[1]: http://archive.healthlawyers.org/google/health_law_archive/p...

Re: Medical equipment pricing is completely broken when a sling costs $200

#282

Post by repiret »

ConcernedCoder wrote: post #176
abhorrence wrote: post #172

Earlier quoted context omitted.

How does this work with institutions like Kaiser? Are their hospitals not technically hospitals? Or are the physicians all technically contractors there?

They are all salaried employees, so Kaiser can work from a 'fixed cost' perspective ( as told to me by a surgical nurse ).

There are there different entities that all work together: Kaiser Foundation Health Plan provides medical insurance. The Kaiser Foundation of Hospitals owns all the hospitals. The Permanente Medical Group, Inc. employs all the doctors. The latter is a Professional Corporation, so its allowed to employ physicians to practice medicine, but it doesn't operate hospitals.

Re: Medical equipment pricing is completely broken when a sling costs $200

#283

Post by camel_gopher »

inferiorhuman wrote: post #130
oppositelock wrote: post #86

Earlier quoted context omitted.

I went to the ER with chest pains seeming like a heart attack. They did an EKG, determined it wasn't a heart attack, then a blood test, which determined it was low potassium, and did a chest x-ray just in case. I received a saline IV and potassium pills as treatment, and went home after a couple of hours. The bill was about $18,000 for this. The insurance negotiated rate was about $1,500, of which I had to pay about…

I ended up in the ER a few months ago. The paramedics wanted around $2,500, the hospital (Dignity Health) wanted maybe $3,500, and the doctor had another few hundred in fees. Sadly that all felt pretty cheap. Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me an…

Did you feel dignified?

Re: Medical equipment pricing is completely broken when a sling costs $200

#284

Post by chanon »

I live in a developing country ... Thailand.

Reading things like this, stories in this thread, and about how people are avoiding seeing the doctor because they're afraid of the bills ... makes me realize in some ways Thai people actually have a higher quality of life than many in US in this respect.

Costs are order of magnitude(s) lower. A night in the hospital is typically 5,000-10,000 baht or $166-$333. And the quality of care is at a good standard .. so much so that Thailand has become a Medical Tourism destination:

https://www.health-tourism.com/thailand-medical-tourism/

If you have some money, you can pay more for faster service and more attentive care at more expensive private hospitals.

And if you can't pay, you are still covered by Thailand's Universal Healthcare:

"What Thailand can teach the world about universal healthcare" https://www.theguardian.com/health-revolution/2016/may/24/th...

"Thailand: At the forefront of Universal Health Coverage" https://medium.com/health-for-all/thailand-at-the-forefront-...

Thailand is a relatively poor country, but we are still able to do this. In the US, I guess some people would rather die than admit needing help from the government ... or trying to clamp down on healthcare costs cause it would be too much 'regulation'?

Re: Medical equipment pricing is completely broken when a sling costs $200

#285

Post by Paul-ish »

noelsusman wrote: post #208
blhack wrote: post #108

Has anyone here ever worked in this industry? I'm curious what the justification for these prices is? I can't imagine it is quite the scrooge mcduck caricature where the people reaping these profits are literally trying to defraud people. I would love to talk to a health insurance insider or something and ask them to justify this stuff.

I've spent my whole career working for hospitals primarily dealing with cost data. There's not much incentive to create a sensible pricing structure because very few patients actually pay the posted prices. Most revenue comes from the government or insurers, and neither of them give a fuck what you charge for a sling. Hospitals have limited resources, and dealing with insurers is a big enough operation as it is. Most…

Non-profit just means they don't pass money on to shareholders, right? That doesn't mean there isn't management taking a large cut. Recently a hospital near my family was bought up by CHI[1], making them the only game in town. Is there any reason to believe prices wont go up?

* https://en.wikipedia.org/wiki/Catholic_Health_Initiatives

Re: Medical equipment pricing is completely broken when a sling costs $200

#286

Post by lotsofpulp »

bryan11 wrote: post #280
oppositelock wrote: post #86

Earlier quoted context omitted.

I went to the ER with chest pains seeming like a heart attack. They did an EKG, determined it wasn't a heart attack, then a blood test, which determined it was low potassium, and did a chest x-ray just in case. I received a saline IV and potassium pills as treatment, and went home after a couple of hours. The bill was about $18,000 for this. The insurance negotiated rate was about $1,500, of which I had to pay about…

Stories like this are scary. My employer based health insurance has an $18,000 deductible before it starts to cover 70% of approved, in-network bills. One visit to ER could easily cost me $20,000. A simple doctor visit can range from $150 to $1000. The effect is that any doctor visit is viewed as a last resort option.

Your employer is screwing the employees via a terrible grandfathered plan. Any new insurance plan after ACA would have a maximum deductible equal to out of pocket maximum, which for 2019 was $15.8k for non HSA and $13.5k with HSA.

https://www.uhc.com/employer/news/consultant/irs-sets-new-20...

https://www.cigna.com/assets/docs/about-cigna/informed-on-re...

But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.

Re: Medical equipment pricing is completely broken when a sling costs $200

#287

Post by Paul-ish »

chillacy wrote: post #179
golover721 wrote: post #97

Another thing that bugs me in the whole "medical cost" disaster that is the USA. Whenever you talk to Doctors or other medical practitioners about the situation they blame the hospitals, or the insurance companies or but ultimately they are complicit in the mess, but they don't want to rock the boat, its just shameful.

The whole system of massive school debt and massive salaries for doctors resting on the AMA artificially limiting the supply and scope of doctors? Yea I'd say so.

> AMA artificially limiting the supply and scope of doctors?

I see people say this, but what does this mean? Should we not certify our doctors? Should just about anyone be able to hang out their shingle?

Re: Medical equipment pricing is completely broken when a sling costs $200

#288

Post by rahidz »

dmitrygr wrote: post #253
jellicle wrote: post #206

Earlier quoted context omitted.

The reason is so that there aren't "boutique" private practices. Keeping the rich people in the same boat as the poor people is actually quite important for the long-term health and welfare of the system. Members of the Canadian parliament have the same healthcare system as anyone else. Thus they aren't terribly tempted to cut it. If private insurance was allowed (in Canada), the elite would have expensive plans that…

So how do you justify to your family that you are voting for someone who will reduce availability of very specialized treatment for them (those boutique doctors), so some random people you've never heard of can have better care "on average"? Becuase that's where I get stuck.

From a selfish perspective, because you run into those random people. When your servers and your retail employees can go to the doctor instead of "waiting it out" because of medical expenses, that's less likely to make you and your family ill.

From a less selfish perspective, there but for the grace of God go you.

Hoy por ti, mañana por mi.

Re: Medical equipment pricing is completely broken when a sling costs $200

#289

Post by lotsofpulp »

IggleSniggle wrote: post #247
greggman2 wrote: post #219

Earlier quoted context omitted.

For one, probably because these stories are the exception? I know a bunch of people will probably tell me I'm wrong and I might be (haven't used the US health system in a 3 or 4 years since I moved out) but for most people their insurance just covers it (or medicade if they're old). Otherwise most people don't want to leave their friends and family Note: not defending the horrible system. Only suggesting that most pe…

Company provided insurance, only cost us $5k to have a healthy pregnancy followed by a healthy baby, with no special circumstances. This was the usual “negotiated” cost. Why not print $2mil for a yearly wellness check while you’re at it, and then give a generous 1.9mil discount? The whole system is absolutely positively bonkers. How much of my premium is going to professional negotiators for insurance, and how much o…

Not much. Your premium is going towards paying for the $1M NICU cases where it takes extreme interventions and the $1M/month hemophilia patients. Even a population of a small state like Iowa can have problems distributing costs like that.

https://www.desmoinesregister.com/story/news/health/2017/05/...

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