Why the medical field is going downhill

[ua_guy]

The government screws up everything it touches, why we would want more of it is beyond me.

Agree with you on a few levels.

From my perspective, many of the asinine requirements and rules that CMS (Medicare/Medicaid) imposes from an administrative standpoint is in the interest of cracking down on abuse and fraud, because we are dealing with taxpayer money. They run a tight ship when it comes to paying expenses, and that's needed. Remember, the goal of CMS isn't to care for patients, it's to pay for the care. They are much like a typical insurance company (payer), except it falls under government administration.

The fallout is the huge administrative nightmare for patients and providers which is also expensive. Keep in mind, CMS probably isn't attracting the best, or highest-paid talent in the industry, either. Yet, they get to set the policies.

[riverwed070707]

A couple more example:


2. There are various forms that I need to fill out periodically that, on a single-page, single-sided form, require me to write the patient's name in 3 different places and sign my name in 3 or 4 different places - on one sheet of paper. Could they not design the form to enter the patient's name at the top and have the doctor sign at the bottom and have that be sufficient?

I kind of feel this way when I make an appt with a new provider: they take all my info by phone, then you come in and fill out 10 forms asking the same info already collected by the receptionist and every form wants you name, DOB, SSN, address, etc... has to be a less painful way to process this paperwork

[AnotherReader]

The provider network I use has gone through two acquisitions in the last 8 years. I no longer have any faith in what they do, because it is completely dictated by the insurance companies. I'm seriously considering moving to the concierge people that are hooked up with the better independent specialists. They will look at your problem and not give you the generic response that is appropriate in 90 percent of the cases but not in yours.

With the demise of my retiree care policy next year and the shift to an exchange policy that's just as expensive for half the coverage, I'm pretty sure I'm going to forego the insurance and just pay cash.

I'm not permitted to post links yet, so I will just recommend the article called "Doctors for the 1 Percent" on Bloomberg today. That's the way all medicine was practiced 50 years ago, until the Kaiser HMO model was unleashed on the rest of the medical world.

[disneysteve]

I'm pretty sure I'm going to forego the insurance and just pay cash.

That's perfectly fine for routine care from your family doctor. The problem is what happens if you actually get sick. A few days in the hospital can cost you tens of thousands of dollars. Very few people can self-insure that type of stuff. Just a visit to an emergency room can cost a couple thousand dollars.

[greenskeeper]

That's perfectly fine for routine care from your family doctor. The problem is what happens if you actually get sick. A few days in the hospital can cost you tens of thousands of dollars. Very few people can self-insure that type of stuff. Just a visit to an emergency room can cost a couple thousand dollars.

I had a coworker who was the cook and he declined insurance saying he couldn't afford it. Ended up needing $10k in medical care through the ER. He sent in $50/month for a few years until they finally just wrote it off. According to him if you make an attempt to pay even a little bit it won't go to collections. This was about 10 years ago so maybe things have changed.

[AnotherReader]

Fortunately, I can afford that possibility. With the premiums, the deductibles and the co-pays, I would have to spend close to $20k before noticing I did not have insurance. Under the ACA, I can move out of state and sign up if I develop an expensive non-emergency problem like cancer. So it's only that massive heart attack, stroke, or auto accident injury I have to worry about. I think that bet may be worth taking.

[krantcents]

I think the inmates have taken over the asylum! Insurance companies have changed medicine and it is not an improvement. Everyone admits that medicine is expensive in the U.S., but the solution of more HMO's are not necessarily better. Doctors are getting less for doing more and the only winners are the insurance and pharmaceutical companies.

[GrimJack]

Fortunately, I can afford that possibility. With the premiums, the deductibles and the co-pays, I would have to spend close to $20k before noticing I did not have insurance. Under the ACA, I can move out of state and sign up if I develop an expensive non-emergency problem like cancer. So it's only that massive heart attack, stroke, or auto accident injury I have to worry about. I think that bet may be worth taking.

Nope - that is not true, the fact that you are not insured is kept track of nationally no by state. The IRS has been tasked with making sure that you are either insured or paying a fine - granted, the IRS will not treat your ACA penalties the same way they treat your tax penalties but just changing states will not work now that they came up with novel new computer stuff.

But on a grander scale - you seem to be taking a pretty selfish attitude "I refuse to pay for something other people need, but as soon as I need it then other people should pay for it."

[AnotherReader]

Moving to another state is a qualifying life event that opens up the insurance policy purchase window. The IRS penalty does not apply if you can't purchase a policy that doesn't exceed a certain percentage of your MAGI. For those folks that have business or asset based income, MAGI is adjustable.

I see no reason to purchase a shoddy, overpriced product when a quality product at a similar price was available to a smaller pool and procured by a group buyer. Any time a pool is created for insurance purposes, the risk profile and the cost change. Buying a policy on the exchange guarantees you personally are subsidizing the sickest people that can't obtain health insurance otherwise. Employer based insurance limits the pool to healthier employed people and therefore you can usually get better insurance for less money.

If you want to insure the less healthy, do what is done in auto insurance, high cost pooled risk. If you insist on taxpayer participation, apply the subsidy there and let the rest of us get on with our lives.

[elessar78]

The government screws up everything it touches, why we would want more of it is beyond me.

Stop it. Gov't is not perfect but have you ever lived in another part of the world? Third world? This is probably as good as it gets.

And the contrast is that would be private business would do it better. No. Private business ----- up A LOT. The one truism that I find everywhere that I've worked at is that despite having a lot of intrinsic problems at multiple levels all the companies I've worked for still were very profitable, some even made gobs of cash. So much they didn't even know what to do with it anymore—that's not an exaggeration.

And they make decisions that, in essence, say ---- the customer, because we'll make money. And guess what? Some of them have stayed in business for close to a century now.

There are many tentacles to this problem. One is gov't. One is private business. To say otherwise is completely naive.

Any human endeavor, because people are imperfect, are going to be imperfect as well.

[UnknownXV]

The problem I see is this. The more the government is involved in financing medical care, for any group, the more bureaucracy creeps in, increasing costs. Beyond the standard increase that accompanies the irresponsibility and mismanagement that comes naturally from government. It's not a conspiracy or anything silly like that, just simple logic. Why on earth would an entity that has unlimited, guaranteed income care about spending money wisely? Well, they don't. You get bureaucratic nonsense that rarely serves a purpose and is merely a hindrance to working people, and inefficient allocation of resources.

I'm in total support of helping those in need. Voluntarily. Get the government out of the picture entirely. Those who have no insurance and no one to help them will depend on private charity for help. Truth is, most people will be just fine on their own. Welfare leads to dependency. Why stand on your own feet when you don't have to?

[elessar78]

The more the government is involved in financing medical care, for any group, the more bureaucracy creeps in, increasing costs.

Except, in the case of health care, costs were increasing annually with no connection to reality.

[UnknownXV]

From what I've seen, there's a substantial correlation between the two. In 1965, with the advent of medicaid and medicare (which account for a substantial portion of all medical treatment in the country) out of pocket expenses went down (so people are less sensitive about costs) and federal / state spending skyrockets.

The other issue is with our progressive tax system. Since paying more leads to further tax burdens, employers started to offer benefits instead, including health insurance. Thus, not only is their less direct cost competition because of the proliferation for insurance in all aspects, but there's less competition for insurance companies themselves because they're mostly provided by employers, for all their employees.

http://mediatrackers.org/national/2013/10/01/8-charts-explain-explosive-growth-u-s-health-care-costs

[elessar78]

Health insurance began being offered by employers after WW2. Because of wage controls due to the scarcity of resources during the war, health benefits were a work around those wage controls—benefits like health insurance did not count as wages.

So the origin of health insurance wasn't tax dodge exactly.

[disneysteve]

Just another doctor rant here

I have a vision-impaired diabetic patient and the society for the blind that works with her recommended she get a meter to monitor her blood sugar that talks so that she doesn't have to read the screen. Of course, insurance doesn't cover that so we had to get prior authorization. It took several phone calls and faxes but we finally got the talking meter authorized.

I gave the patient the prescription to get the meter and supplies and gave her a copy of the authorization letter in case the pharmacist didn't have it and thought that was the end of the story.

Nope. Today, I get two denial letters. The meter is covered but the supplies needed to actually use the meter aren't covered. We need to go through the whole prior authorization process again to approve the test strips and lancets necessary for the meter.

So basically they approved a piece of medical equipment but won't approve actually using that piece of equipment. What sense does that make? Now my staff person needs to waste another hour on the phone to get the supplies authorized.

On an unrelated topic, one of the many standard (and required) vaccines for children is for meningitis. The vaccine costs us $100/dose to purchase. In the past week, we got reimbursed for giving 2 of those vaccines to our patients. One insurance company paid us $68. One paid us $90. So just on those 2 doses, we lost $42 plus the cost of the syringe, gauze pad, alcohol wipe, bandage, and my medical assistant's time. How is a doctor supposed to run a business like that?