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The fight between doctors and insurance companies over 'downcoding'

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Re: The fight between doctors and insurance companies over 'downcoding'

#281

Post by iamnothere »

hibikir wrote: post #140
iamnothere wrote: post #57

Earlier quoted context omitted.

A reasonable wage or salary isn’t usually considered “profit” in a legal sense. This is why nonprofits can still pay employees. Any money that is left over after costs (including wages/salaries) needs to be reinvested, spent on the organizational mission, or held for future use, not distributed through dividends or other distributions as in a for-profit enterprise.

Have you spent much time looking inside non profits? A lot of hospitals in the US are non profits. Some are part of non profit universities too. This in no way leads to superior cost controls, or those universities being cheap. What it does mean is that they get some significant tax advantages (for instance, no property taxes), and that there's fewer optimization incentives. When you limit yourself to the US definiti…

Studies have shown both a decrease in care outcomes and higher costs for private hospitals: https://pmc.ncbi.nlm.nih.gov/articles/PMC419772/ https://www.buffalo.edu/news/releases/2002/05/5712.html

Re: The fight between doctors and insurance companies over 'downcoding'

#282

Post by viraptor »

doctorpangloss wrote: post #261
oakmad wrote: post #243

I’ve lived under several different healthcare systems around the world as an adult. Coming from my time America, nothing felt more like freedom to me than walking out of a hospital in London, with a new child, and having had no interaction with a billing desk.

On the other hand, aren’t comments like yours about the aesthetic experience of billing exactly the problem? It’s not like you didn’t pay for healthcare in Europe, you just had good vibes about the particular way that you paid. Employer sponsored health insurance plans are popular and also give good vibes.

> also give good vibes.

I've heard enough "can't afford the risk of changing jobs" and "current work sucks, but I have to have insurance for my current issues". Honestly it doesn't feel like good vibes, especially with the recent issues on the job market.

Re: The fight between doctors and insurance companies over 'downcoding'

#283

Post by nhinck3 »

teleforce wrote: post #250

If anyone wondering why it is call 'downcoding', it's because there's WHO ICD coding standard or international classification of diseases now at version 11 or ICD-11 [1]. It's mainly used for classification of disease mortality not morbidity, not until the latest version iteration of ICD-11 in which it now caters for both [2]. Due the usefulness of the diseases classification coding based on ICD, it's also being used…

Just to add on, it's called coding because it was, at one point, the act of taking chart notes and turning them into ICD codes.

Re: The fight between doctors and insurance companies over 'downcoding'

#284

Post by tptacek »

zaptheimpaler wrote: post #203
tptacek wrote: post #202

Earlier quoted context omitted.

Or I could just look at the numbers and see that providers make more than 8x what insurers do.

And yet this has absolutely nothing to do with the claim that "Insurance companies hold tremendous leverage over care providers, up to and including the power to effectively put them out of business on a whim.", you're not even engaging with the argument at all.

It doesn't? All the money is going to them, and they're massively larger than the insurers, but it's the insurers with all the leverage? Why isn't more of the money going to the insurers then?

https://nationalhealthspending.org/

Re: The fight between doctors and insurance companies over 'downcoding'

#285

Post by throwaway173738 »

827a wrote: post #185
testing22321 wrote: post #169

Earlier quoted context omitted.

> Kaiser should be selling me an annual plan where everything at Kaiser is covered, maybe up to a point, and then they have insurance-like network relationships with e.g. other ERs in the area, if you need them, plus out-of-area addons for when I'm traveling. If you’re trying to solve them problem, why on earth do you propose such an expensive, convoluted and strange solution? Two dozen countTies have solved this. It…

What I want is simple: For change to actually happen. You don't need to convince me; your choice is either to convince 100M+ unreasonable people, or make a reasonable path. Direct to consumer billing is that reasonable path; that's why we're seeing it take hold in the dental, vision, and pharmaceutical industries. Core medical is next. Specialty medical will follow. Emergent medicine might never change, but that is a…

The real problem is that the insurance companies will find reasons to charge the same amount even though they have no providers in network.

Re: The fight between doctors and insurance companies over 'downcoding'

#286

Post by harvey9 »

danpalmer wrote: post #273
harvey9 wrote: post #254

Earlier quoted context omitted.

I read the post you replied to as simply meaning it's a non bad thing, not that it is better care than elsewhere.

Perhaps that was all that was intended by it, if that's the case I guess I don't have a problem with it, the US does have competent clinicians. But my interpretation was a rebuttal to the cost, linking it and suggesting that paying so much gets you better healthcare, something I have heard from defenders of the US healthcare system in the past. As far as I understand it this link is not causal.

In Britain you generally get the exact same Consultants working in the public and private sectors. Private hospitals have shorter wait times so on that measure, paying gets a better service. Comparing outcomes is complicated since the private sector only sees patients with more wealth

Re: The fight between doctors and insurance companies over 'downcoding'

#287

Post by herbst »

throwaway173738 wrote: post #278
doctorpangloss wrote: post #261

Earlier quoted context omitted.

On the other hand, aren’t comments like yours about the aesthetic experience of billing exactly the problem? It’s not like you didn’t pay for healthcare in Europe, you just had good vibes about the particular way that you paid. Employer sponsored health insurance plans are popular and also give good vibes.

Who have you talked to that enjoyed dealing with their insurance provider? Every single provider I’ve had had nightmarishly complicated customer support who couldn’t be trusted to give you accurate information.

Being in Switzerland. I don't mind talking to mine. So far they paid for everything I needed, they are a big company easy to deal with fast in communication which I barely need as doctors usually deal with them their self.

Imagine: I just pick a doctor, make an appointment whenever I need help for anything. They then do everything else and I just pay my monthly fee, that is basically the same for anyone. Zero hassle.

Re: The fight between doctors and insurance companies over 'downcoding'

#288

Post by leoh »

harvey9 wrote: post #254
danpalmer wrote: post #245

Earlier quoted context omitted.

Are clinicians any more competent than in other countries with similar levels of training? In Europe, UK, or here in Australia for example, the quality of public care seems to be competitive with the US, and the quality of private care here seems often even better. I've heard this "US healthcare is expensive but at least it's good" thing a few times, but never with any particular evidence, and from the few numbers I…

I read the post you replied to as simply meaning it's a non bad thing, not that it is better care than elsewhere.

Right. That said, I actually do suspect the 95th percentile of clinicians may be better in the US. I’m not sure, though.

Re: The fight between doctors and insurance companies over 'downcoding'

#289

Post by nradov »

teleforce wrote: post #250

If anyone wondering why it is call 'downcoding', it's because there's WHO ICD coding standard or international classification of diseases now at version 11 or ICD-11 [1]. It's mainly used for classification of disease mortality not morbidity, not until the latest version iteration of ICD-11 in which it now caters for both [2]. Due the usefulness of the diseases classification coding based on ICD, it's also being used…

No, that's completely wrong. Downcoding has nothing to do with ICD versions. This article is talking about changes to the billed HCPCS (including CPT) codes to ones with lower rates. Most US healthcare claims do include at least one ICD-10-CM code to indicate the diagnosis but this is just supporting information. Payers don't change diagnosis codes. ICD-11 isn't used on US claims at all, although it might be adopted in a few years.

Re: The fight between doctors and insurance companies over 'downcoding'

#290

Post by Workaccount2 »

arethuza wrote: post #256
malfist wrote: post #232

Earlier quoted context omitted.

Put yourself in my shoes last year. You go to your doctor, you have a suspected tick bite with a bullseye pattern around it and a red streak running away. Your doctor is concerned about tick born illnesses and the red streak suspecting the start of sepsis. They need to determine asap if they can treat you with docycline or if you need IV antibiotics. They need to assess your blood for a CBC to determine immediate ris…

I had a tick bite that was irritated (but not a bullseye rash that I could see) - phoned GP practise, doctor phoned me back a couple of hours later and discussed the situation, ruled out blood tests because they said they were inconclusive at best and arranged for a 3 week course of antibiotics. My wife picked them sup from a pharmacy later that afternoon as she was in town anyway. No direct costs, no mention of mone…

You are getting snagged on the surface level discussion about tick bites, rather than the real discussion about the complexity of medicine.
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