321–330 of 354 posts
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Are you calling it the magical land because it doesn't exist? I doubt your doctors office can commit a cash price for the lab they sent you blood too. And try doing that at a hospital and see where it gets you
> I doubt your doctors office can commit a cash price for the lab they sent you blood too. Why the hell not? This is not a difficult problem to solve under the "Classical Capitalism" model.
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> I doubt your doctors office can commit a cash price for the lab they sent you blood too. Why the hell not? This is not a difficult problem to solve under the "Classical Capitalism" model.
Because they don’t own the lab? It’s an entirely separate business?
I've seen a lot of upcoding on my bills and it really aggravates me. It's fraud and the doctors should be happy that the insurance company is just reducing their payments instead of dropping them or trying to get them prosecuted. When someone loads their grocery bag full of cosmetics and razor blades, they get on the news and YouTube, but when a doctor systematically bills for services he didn't perform to the tune o…
What does this part mean? I don't follow.
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There are viruses that can last 2 weeks and mimic bacterial infections. Most cases of bacterial infection will also clear on their own after 2 weeks. There are no good noninvasive diagnostic tests to distinguish bacterial sinusitis from viral because is the presence of normal nasal flora. The standard of care is to consider antibiotic treatment after 2 weeks of symptoms for adults and 3 weeks for children. There’s a…
Standard of care for persistent symptoms compatible with acute bacterial rhinosinusitis for more than 10 days IS prescribing antibiotics.
I'm on the side of the insurance companies. they are likely the only "responsible adults" keeping providers in check. Providers are extremely wasteful and "creative" with their billing. Staff are generally idle, and staff-to-patient ratios are 10-20:1 if not more. There is little urgency around the clinic, staff take off at 4pm and are impossible to catch on a Friday. Every procedure bills a redundant and pointless "…
Healthcare insurance companies are completely pointless because healthcare is a human right. All other developed countries have figured this out and provide healthcare universally. We could fully socialize “healthcare insurance companies” and have exactly zero negative repercussions. The only outcome would be eliminating a useless industry and saving ~$500 billion a year.
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Most doctors don’t do their own billing. It’s too complex. They have specialists who take their notes and turn them into bills.
while you're right most of the billing pressure is likely coming from administrators and boards, doctors do participate with petty / pointless consults , excessive testing & procedures, absurd hour restrictions, and indirectly through medical boards reducing capacity, among other factors
My wife has served on government medical advisory boards, and handles resident education. I've heard plenty of virtual meetings in the background. I've never once heard anyone discussing adding requirements for any unnecessary reason whatsoever. Not even a hint anything that would reduce capacity. If anything it's "how can we add capacity without reducing quality?"
>absurd hour restrictions
What do you mean by hour restrictions? The only hour restrictions that are enforced are on Residents and that is 80 hours per week.
If you're talking about doctors choosing to work less than 40 hours per week, that's general because they'll completely burn out. My wife is a pediatric ER doctor, she works less than 40 hours per week, but she has no set schedule and could be working 7a-4p one day, 1p-11p the next, and 10p-7a the next. For many of those shifts she's the only doctor there, and is responsible for the life and death of every single patient that walks through the door. She's the one who gets to tell a young mom that her 3 year old has a brain tumor, she's the one who has to code an already dead 5 year old found face down in a pool victim for an extra 15 minutes so her parents can get there because studies have shown it helps them process grief if they can see people doing everything they can to save their kid. And to top it off any mistake she makes could literally cost us our house because it's relatively common in our state for people to awarded judgements that are larger than malpractice insurance limits.
If she worked 40 hours a week she'd be completely burned out in 6 months.
>excessive testing & procedures
You can 100% blame fear of litigation for that. My wife is constantly balancing her desire to save patient's parent's money with her desire to get answers and her fear of legal liability.
>petty / pointless consults
You can blame fear of litigation for that one too. Calling in a specialist for a consult works the same as testing. It's a balancing act.
I know a lot of doctors, some of them are assholes, but I don't know a single one who even consider changing their treatment recommendations based on how much money it nets them.
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You wrote they had 25% margins. And obviously a business with 2% profit margins is incentivized to spend less, if they didn’t, they would be out of business!
Gross versus net margin. The other commenter was saying they don't have incentives to cut costs because of the MLR limit, but that limit is a 25% margin over the cost of their "product." For a product that boils down to just moving money around, 25% is pretty good. This is illustrated by the fact that they aren't actually bumping into the legal MLR limit currently. It would make sense if they don't care about cutting…
I don’t know where you are getting 25% from. See exhibit 2:
https://www.oliverwyman.com/our-expertise/insights/2024/sep/...
Medical loss ratios float between 80% to 90%, leaving 10% to 20% for operating costs and profit.
Their “product” requires enormous manpower to negotiate contracts, handle customer service, lawyers for the government, and most of all, employ doctors and pharmacists to adjudicate claims.
> It would make sense if they don't care about cutting costs because the law doesn't allow them to spend less, but that's not where they are at the moment.
Of course, and the obvious fact of the matter is insurance prices are heavily regulated and there is competition, so they already have an incentive to control costs in order to control premiums. Which is literally what their customers pay them for, to negotiate with healthcare providers with whom customers usually wouldn’t have leverage against.
>If they could cut their medical spending by 1% they could increase their profit by 40%.
Sure, but in industries like insurance and retail, the low single digit profit margins indicate a more pressing need to survive, rather than increase nominal profit.
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Gross versus net margin. The other commenter was saying they don't have incentives to cut costs because of the MLR limit, but that limit is a 25% margin over the cost of their "product." For a product that boils down to just moving money around, 25% is pretty good. This is illustrated by the fact that they aren't actually bumping into the legal MLR limit currently. It would make sense if they don't care about cutting…
> The other commenter was saying they don't have incentives to cut costs because of the MLR limit, but that limit is a 25% margin over the cost of their "product." For a product that boils down to just moving money around, 25% is pretty good. I don’t know where you are getting 25% from. See exhibit 2: https://www.oliverwyman.com/our-expertise/insights/2024/sep/... Medical loss ratios float between 80% to 90%, leaving…
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> The other commenter was saying they don't have incentives to cut costs because of the MLR limit, but that limit is a 25% margin over the cost of their "product." For a product that boils down to just moving money around, 25% is pretty good. I don’t know where you are getting 25% from. See exhibit 2: https://www.oliverwyman.com/our-expertise/insights/2024/sep/... Medical loss ratios float between 80% to 90%, leaving…
The legal minimum MLR is 80%. So if you spend X, the maximum revenue you're legally allowed to have is X * 1.25.
Medical loss ratio = medical expenses divided by revenue.
Margin = money left over after various expenses divided by revenue
So if revenue is $100, and medical expenses are $80, then the remaining funds are $20, or 20% margin.
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In my experience, its not so much what the NHS won't fund but getting access to what it does fund in a timely fashion. Of course there is dentistry, which is a complete nightmare... people trying to do their own extractions with a pair of pliers is the sort of thing you used to associated with the US but I've actually met some people who have tried that due to how poor NHS dental services are and how expensive privat…
Weirdly enough the US is actually amazing for dentistry. With any insurance you get 2 cleanings every year fully included and most routine fillings are almost completely covered. Easy to find appointments everywhere My experience in Europe has been that it is super difficult to schedule anything. Waiting time of multiple months for new patients.