In deference to Beenben - ask hobbes a medical question

[renodoc]

To Pons and Utah etc:

The problem is multifaceted.

The biggest issue is the infiltration of third party payers which have destroyed the traditional doctor-patient relationship. The government is the largest transgressor. Physician payment from treating medicare patients is based on a list of codes (which are owned by the AMA) and then translated into a "resource based relative value scale" This number is then multiplied by a magic formula that congress comes up with each year and the fee is then created. The patient usually pays 20% of this number (or they have a secondary insurance that picks it up)

This is price-fixing at the highest level. Sometimes there are treatments that are new and it is unclear whether or not medicare will pay for them. I am not allowed to accept cash from a medicare patient if they want to pay out of pocket. I am not allowed to charge a medicare patient *less* than the fee schedule also. The Commisars would be most unhappy if I did so.

The fee schedule, run by the gov't, makes little sense. For example, say I get paid $1100 for performing a one hour surgery consisting of procedure X. Another procedure, Y is also sometimes done for the same condition and it pays me $1000, about the same. In fact, there are some patients who get procedure Y first, it fails, and then sometime a month or two later they need procedure X. In this case I would get paid for both. Now take the case where I determine that the patient needs both procedure X and procedure Y at the same initial surgery. Payment is the same $1100 as if I just did procedure X.

Does that make sense?

I strongly believe that our lawyer friends are causing a lot of the problem also. If we can truly move into a situation with real limits on malpractice awards I think it will help. This is another discussion.

[Utah]

The problem with the price fixing is exactly the problem. However, how does 3rd party payers destroy the system? Is the problem with the 3rd party payers in the way they operate or is the problem simply inherent in having 3rd party payers - i.e., if your statement is correct, can the system be fixed and yet still allow for 3rd party payers?

[adsman]

[ QUOTE ]


It is your life and your health. A good doctor can help, but in the end it is your problem. My wife is an endocrinologist. If you have diabetes, she can teach you how to manage your diet, lifestyle and medications to keep your blood sugars under control. This will prevent early heart disease, stroke, renal failure, blindness, erectile dysfunction and a whole host of other costly problems. If you don't/can't follow the plan, there is nothing she can do and it is only a matter of time before I'm taking expensive care of your complications in the ICU. Where is the failure in the system? It's your life, take some personal responsibility for it.

[/ QUOTE ]

Well said. We live in a society where less and less people actually take responsibility for their lives and actions. People just want a quick fix. They want a magic pill to solve their problems.
This includes finding a good doctor. Don't just go to the first one and take his word as gospel. Do some research, ask around. Put some effort into your life.

[renodoc]

[ QUOTE ]
The problem with the price fixing is exactly the problem. However, how does 3rd party payers destroy the system? Is the problem with the 3rd party payers in the way they operate or is the problem simply inherent in having 3rd party payers - i.e., if your statement is correct, can the system be fixed and yet still allow for 3rd party payers?

[/ QUOTE ]


I think a good idea has become a travesty. If we changed all medical insurance to catastrophic coverage (i.e. $5000 deductable or greater policies that would be relatively inexpensive to carry but immensely valuable should you ever need to use it) and then recreated the situation where the doc and the patient worked out a reasonable fee for the more mundane aspects of care that would be a start. Throw in a decrease in the amount of defensive medicine practiced (lab tests, MRI's, etc) and costs continue to go down. The docs overhead decreases also- we have a full time "insurance authorization" person as well as one and 1/2 full time billers. I like these employees, but in the grand scheme they would have to find other work.


3rd party payers interfere with the doctor patient relationship. Just yesterday I saw a woman with a lesion in her eye that looked like a melanoma. We were not "providers" for her insurance and she was told to go to another office for evaluation, even though we are really the only guys who do this kind of stuff here. The doc she was shuttled to isnt even a retina guy- big mistake.

Other times patients will come in only with authorization to look at them. Many patients with retina disease need prompt diagnostic testing and treatment, much of which can be done on the same day. We have to jump through hoops talking to high school educated folks who will decide whether what we are reccomending is "medically necessary" and whether they want to authorize it or not.

If you took all that crap out of the picture, I could charge less since I wouldn't be wasting so much time and could get rid of a couple employees. (I would presumably be paid that day and not 3 months later after two insurance denials blah blah blah)

[Utah]

[ QUOTE ]
It is your life and your health. A good doctor can help, but in the end it is your problem. My wife is an endocrinologist. If you have diabetes, she can teach you how to manage your diet, lifestyle and medications to keep your blood sugars under control. This will prevent early heart disease, stroke, renal failure, blindness, erectile dysfunction and a whole host of other costly problems. If you don't/can't follow the plan, there is nothing she can do and it is only a matter of time before I'm taking expensive care of your complications in the ICU. Where is the failure in the system? It's your life, take some personal responsibility for it.

[/ QUOTE ]The freakin frustrating thing is that consumers simply will not follow the plans even when you tell them they are headed for major problems. Almost 50% refuse to ever really get engaged and 50% of those who start drop out quickly. So, you are starting with a 25% success rate at best and that is before you even get started.

Certainly, it is the consumer's responsibility. However, I think there are massive and effective changes we can make to care management. The problem is often business related. For example, the company I was consulting for will simply never change or admit to itself that the programs dont work because it would destroy part of their business.

[hobbes9324]

false
out of 44 MD's in my group five are DO's - and are at least as bright and hard working as the MD's.

If anything, its more difficult to get into a DO program than an MD program, and the training in each is very much the same.

[ElaineMonster]

Hobbes,
I just had a routine physical with bloodwork. Everything's cool except my cholesterol is too low. HDL = 34 and LDL = 59. Doc said to exercise more. Is there anything else I should do? Why is this even a problem?
Thanks.

Edit: Without Dr's advice I've decided to start drinking a glass of red wine daily. I think this is a good idea. What do you think? [img]/images/graemlins/smile.gif[/img]

[west_eh]

Hobbes, is there a correlation between cannabis and epilepsy?