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Campfire 'Bwana
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Campfire 'Bwana
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Please do not mistake me as being put out with the entire medical community. That is not the case. I have been associated with many worthy individuals in the field. Many!
As for me, any of my alleged ailments are of really little concern to myself. What I have observed in the past 25 years is what the wife has been thru beginning with viral cardiomyopathy in ‘91. And peaking in 2012. And sliding downhill from there. There were things that were overlooked or maybe ignored. Since 2012 she has been diagnosed with three different cancers. One still active after two surgerys, and now it’s back a third time. Another surgery the experts feel is out of the question as her survival rate for that “third time’s a charm" addisional surgery would not be stellar. And to think if her PCP would have been on his toes and just listened to her, this cancer could have been nipped in the bud.
Her cancelled heart transplant was an oversight by a certain transplant team memeber from the get go too! This whole affair has been quite a convoluted “comedy or errors". It seems that one malady simply the result of just another oversight.
So today Im off for a visit to her at the assisted living facility. Coming up on a year there next week. I am just not able to give her the care she needs since the strokes. She does not understand this. I hope she will be in a better mood today that for the past two weeks. Least we got her off all the opioids. With her particular stroke damage, how can I explain this, she cannot synthisize (?) her emotions. No control, no filters. No control of temper.
We have earned the right to be a bit cynical and skeptical of things.
Founder
Ancient Order of the 1895 Winchester
"Come, shall we go and kill us venison?
And yet it irks me the poor dappled fools,
Being native burghers of this desert city,
Should in their own confines with forked heads
Have their round haunches gored."
WS
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Please do not mistake me as being put out with the entire medical community. That is not the case. I have been associated with many worthy individuals in the field. Many!
We have earned the right to be a bit cynical and skeptical of things. i understand perfectly. that's one reason that medicine like some other fields are referred to as a practice. a little off center from the thread, but i'm amazed at the number & amount of big pharma advertising on tv, aimed at consumers. forget the doctors, go straight to the sheep!
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Campfire Sage
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I think Quik Kghunt died quicker than he'd expected.
Shoulda called Mayo.
Trump being classless,tasteless and clueless as usual. Sorry, trump is a no tax payin pile of shiit. My young wife decided to play the field and had moved several dudes into my house
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Campfire Kahuna
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Campfire Kahuna
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I doubt it's so much the "medical community" as it is the insurance companies, govt. regulations, bean counters, and people abusing the system.
I doubt it can ever go back to being an affordable, efficient system.
Too damn many people with their finger in the pie... And the losers are those that need the help.
Molɔ̀ːn Labé Skýla!
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Campfire 'Bwana
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Campfire 'Bwana
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In general:
An new RN now generally has a BSN (bach of sci nrsg), maybe a Masters, can even have a PhD. There are well-paying jobs.
Guessing here $40-80k+/yr depending. Acts on phys orders unless in capacity of admin.
A nurse practitioner is an RN who goes on advanced training in “general practice” might have a Master degree. Could have a PhD. They are often called ARNP and are in many specialties. Many have at least an MS and more and more, a PhD or other terminal degree. Some of these like nurse anesthesia are at about the top of the anticipated income pyramid; ie, $150k -300/annum depending. Many states give them prescriptive authority and they can practice autonomously. Can also work under a physic.
A Phys Assist does roughly the same, or can, as the above but is more limited in the spheres they can work (ie, cannot do anesthesia for one thing); becomes a PA-C — physician assistant - certified. Surgeons, particularly orthopods, use these in the OR and in the clinic. Can work under a physic or autonomously with physic as back-up.
MD’s and DO’s are physicians and depending upon specialty and post-grad training earn varying incomes from $150k to much higher.
Health care is becoming more and more dependent on “extenders” or nurse practitioners or phys assist’s as a matter of logistics and economy.
Pretty much what I've seen. We use ANP's and PA's (grouped together as APP's, Advanced Practice Providers) in every ER I work in these days, and we couldn't get by without 'em. Their scope of practice is limited, and rightly so, but as Kevin pointed out previously, a specialty APP will know more about that specialty field than most MD's who aren't in that field, so their value to you as a patient can be really high. I have steered a couple of young people away from medical school in recent years, advising them to get their bachelor's degree in nursing, then get an advanced degree as a nurse-anesthetist or ANP as a more cost-effective alternative. Most young docs I talk to these days graduate with more than $300K in student loan debt, which will take decades to pay off at current pay rates. Doctor salaries aren't what they used to be (compared to other professions) as corporate medicine becomes the norm and MBA's make most of the decisions. I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system. This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
Excellent posts Doc and George. Now, as to that last highlighted sentence of yours Doc. HOW DO WE FIX THAT???? I'm nearing Medicare age so I've seen many changes in my health care delivery systems I'm not particularly happy about. And the bureaucracy determining my treatment options and timing thereof are surely one of the most detested changes I've seen. Any ideas how to address this issue? Without going "UnAmerican" and removing the profit motive driving the corporate changes to the system that is. That would surely piss off a lot of people here.  Geno
The desert is a true treasure for him who seeks refuge from men and the evil of men.
In it is contentment
In it is death and all you seek
(Quoted from "The Bleeding of the Stone" Ibrahim Al-Koni)
member of the cabal of dysfunctional squirrels?
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Medicare and Medicaid have driven our prices up exponentially I can assure you. So have private insurance companies.
Example
Say I stitch you up. Depending on the complexity of the laceration, the type of equipment used, and the time it takes me I bill at a certain rate.
For ease of math let’s say 250$ Equipment cost was 125$. That’s for my services and equipment used. Not the actual Er bill for room and nurses and all that
Medicare says well we won’t pay that. We will give you 125$
So instead we have to find ways to bill for things just to pull any money in, which means the overall bill has to be higher. insurances will negotiate and only pay percentages and it makes it very hard for a hospital to cover costs and stay fluid. Even if we billed the bare minimum for only the absolute necessary things we use they will only pay a percentage
Now you know why there are very few community hospitals that can keep head above water, and instead have to join larger hospital groups.
If a carpenter came to your house and installed crown, you only gonna pay a percentage and he eats the rest. Not how it works in real world
Nothing is free. You want good quality healthcare it costs money, lots of it. Same as any large business with huge operating costs
First step in lowering costs is getting government oversight reduced. Just look up the joint commission. These azzhats are real pricks and can basically come in and dictate all kinds of unnecessary bull crap that costs hospitals a fortune, or they will shut you down.
Some of the oversight is necessary, but not to the extent that it is now
How about the fact that medical liability is so crazy and litigious that I can be sued even if I do everything right, and you have a poor outcome. Might not win in court but it’s gonna cost a bunch of money to fight it.
You should not be able to sue a doctor or medical professional for anything except gross negligence. If I follow the accepted standards of care, and do what any other person with my level of training and experience would do I shouldn’t be held liable for a negative outcome
I have worked at 2 community not for profit hospitals. One had such a large uninsured population it went bankrupt because you can’t spend more than your bringing in. Joined a large corporate hospital network and the quality of care is now terrible in my opinion
The one I currently work at ( I’m a contractor and not a employ, but was employed there for 10 years) is still community based and not for profit, and they would have gone under if not for past CEO being very smart and investing lots of money in the past. He understood eventually hospitals will only lose money. They do a great amount of services for the community that they do not even bill for
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Campfire Outfitter
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Pretty much what I've seen. We use ANP's and PA's (grouped together as APP's, Advanced Practice Providers) in every ER I work in these days, and we couldn't get by without 'em. Their scope of practice is limited, and rightly so, but as Kevin pointed out previously, a specialty APP will know more about that specialty field than most MD's who aren't in that field, so their value to you as a patient can be really high.
I have steered a couple of young people away from medical school in recent years, advising them to get their bachelor's degree in nursing, then get an advanced degree as a nurse-anesthetist or ANP as a more cost-effective alternative. Most young docs I talk to these days graduate with more than $300K in student loan debt, which will take decades to pay off at current pay rates. Doctor salaries aren't what they used to be (compared to other professions) as corporate medicine becomes the norm and MBA's make most of the decisions.
I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system.
This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
I am a Neonatal Nurse Practitioner (now retired). I wholeheartedly agree with you Doc, especially the red highlighted parts. Back about '95 I looked into going to med school to up grade from NNP to MD. I found that the average MD/DO graduated with about $250k debt. The average cost of starting a new solo practice was about $250k not to mention maintaining staff, equipment, liability insurance, etc. I checked around with local physicians and found that the typical salary in my area for a Pediatrician joining a large practice was $90k with a top of about $120k, the solo guys were topping at about $160k (+ headache of running your own business and 24/7/365 on call). I was making $80k and had a good pension plan in place (PERA). One physician explained to me to not discount that pension in my plans. I figured out that to pay off the debt I would not only be effectively working for far less than I was currently making but would not be contributing toward retirement as well as my current pension plan. Did I mention wife and two kids? I also agree about the admin part, it mirrors what has happened in colleges/universities. Big government infusion of cash (loans) and admin balloons massively yet teacher salaries have not kept the same pace as the increase in tuition.
Ed
A person who asks a question is a fool for 5 minutes the person who never asks is a fool forever.
The worst slaves are those that put the chains on themselves.
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Campfire 'Bwana
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Campfire 'Bwana
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I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system.
This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
The orthopedic surgeon who did my ankle recently said that he joined his practice in 2001 and since that time they've kept the same number of MDs, same number of support staff, and same number of patients. Today he's making less money, and we're all paying higher premiums. And the prior year United Health Care made a $3B profit. That's not where I want my medical dollars going.
A wise man is frequently humbled.
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Campfire Ranger
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I have two Doctors that most of the time I see a PA. One is much better than the Dr and helps me.The other thinks a lot more of himself than others do.My Primary care physician is so-so. About the only think great is he has no qualms about referring me to specialist that I choose.
If God wanted you to walk and carry things on your back, He would not have invented stirrups and pack saddles
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Campfire Outfitter
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I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system.
This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
The orthopedic surgeon who did my ankle recently said that he joined his practice in 2001 and since that time they've kept the same number of MDs, same number of support staff, and same number of patients. Today he's making less money, and we're all paying higher premiums. And the prior year United Health Care made a $3B profit. That's not where I want my medical dollars going. Remember that $3B is not going to an individual but mostly going to stock holders many of which may be pension plans, IRAs, etc. That money goes round and round.
Ed
A person who asks a question is a fool for 5 minutes the person who never asks is a fool forever.
The worst slaves are those that put the chains on themselves.
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Campfire 'Bwana
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Campfire 'Bwana
Joined: Sep 2011
Posts: 45,120 |
I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system.
This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
The orthopedic surgeon who did my ankle recently said that he joined his practice in 2001 and since that time they've kept the same number of MDs, same number of support staff, and same number of patients. Today he's making less money, and we're all paying higher premiums. And the prior year United Health Care made a $3B profit. That's not where I want my medical dollars going. Remember that $3B is not going to an individual but mostly going to stock holders many of which may be pension plans, IRAs, etc. That money goes round and round. Yep, the $3B is the reason we all pay so much for insurance. Hopefully, one is "invested" in something their medical cost monies are being invested in so they can get some benefit out of their spending later in life. Geno
The desert is a true treasure for him who seeks refuge from men and the evil of men.
In it is contentment
In it is death and all you seek
(Quoted from "The Bleeding of the Stone" Ibrahim Al-Koni)
member of the cabal of dysfunctional squirrels?
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Campfire Ranger
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Campfire Ranger
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UPMC had 32employees who earned at least $1 million,
10 that earned $2 million,
Jeffrey Romoff, the CEO earned $6.5 million.
But I helped.
I had a CT scan at the ER.
The $175 copay was expected, that's fine.
I still don't understand why I got the $1200 bill for the scan.
But,
UPMC hospital,
UPMC doctor,
UPMC testing,
UPMC insurance.
If the insurance pays, they just move money.
If they can make Karl pay,
they make $1200.
It feels good knowing this factory worker helps a millionaire pay his bills.
One who has done nothing for me.
This isn't class envy.
The doc who helped me is much better played than I.
And he deserves his money, I owe him.
Parents who say they have good kids..Usually don't!
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Campfire 'Bwana
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Campfire 'Bwana
Joined: Sep 2011
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Can anyone in the field explain why a 'Medical Care Union", similar to the Credit Union model would NOT work, especially in rural areas where profit margins are low and hiring new medical professionals is difficult to accomplish for a variety of reasons?
Credit Unions essentially put "profits" back into their members' pockets in the form of lower rates on loans etc. Same could be said for the Rural Electrical Co-ops (of which I've been a member of three), which in every case I know of provide electrical service equal to or better than the big for profit corporations (PG&E, ConEd, etc) for a lower rate. Substantially lower in the case of where I live now, lowest rates in California. And the best service I've seen when there is a problem.
I'd sure like to see an experimental Medical Care Union get started here, but that's not likely now that the local hospital made $2 million + this past year, and I think something near that the year before. We're getting a brand new facility too, being built as I type.
Maybe I should check to see who the owners of the local hospital are so I can invest in them. Unfortunately, that's hard to do on a retirement income. Or for the lower income folks in our service area, of which there are many.
Geno
The desert is a true treasure for him who seeks refuge from men and the evil of men.
In it is contentment
In it is death and all you seek
(Quoted from "The Bleeding of the Stone" Ibrahim Al-Koni)
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Campfire Outfitter
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Yep, the $3B is the reason we all pay so much for insurance. Hopefully, one is "invested" in something their medical cost monies are being invested in so they can get some benefit out of their spending later in life.
Geno I don't think so, I believe that much more of the cost is due to treating people that don't have the means to pay which is spread out to all insurance holders (those that do pay) and the cost of liability insurance and legal representation. I don't understand why people think that businesses should not make a profit. That $3B sounds like a lot of money but what % is it of the amount that UHC spends on buildings, maintenance, medical equipment, employees, medical supplies, etc? Some money could be saved by cutting down on admin costs - far too many administrators making inflated salaries.
Ed
A person who asks a question is a fool for 5 minutes the person who never asks is a fool forever.
The worst slaves are those that put the chains on themselves.
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Campfire Ranger
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Campfire Ranger
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Yep, the $3B is the reason we all pay so much for insurance. Hopefully, one is "invested" in something their medical cost monies are being invested in so they can get some benefit out of their spending later in life.
Geno I don't think so, I believe that much more of the cost is due to treating people that don't have the means to pay which is spread out to all insurance holders (those that do pay) and the cost of liability insurance and legal representation. I don't understand why people think that businesses should not make a profit. That $3B sounds like a lot of money but what % is it of the amount that UHC spends on buildings, maintenance, medical equipment, employees, medical supplies, etc? Some money could be saved by cutting down on admin costs - far too many administrators making inflated salaries. i think this is probably an important part of the real dilemma we all face. the service providers are almost required to hire and expand the services provided by the administrators. there's the federal gov't with it's big guns of enforcement, and policy setting. competitors, let's don't forget the competitors, state & local regulators, and big pharma. medical equipment developers & marketers (what to buy and what not to buy?). a well versed and connected administrator might well be worth his/her weight in gold? but, yes i get your drift. useless overhead is a drain on precious resources.
Last edited by Gus; 06/09/19.
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Campfire 'Bwana
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Campfire 'Bwana
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I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system.
This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
The orthopedic surgeon who did my ankle recently said that he joined his practice in 2001 and since that time they've kept the same number of MDs, same number of support staff, and same number of patients. Today he's making less money, and we're all paying higher premiums. And the prior year United Health Care made a $3B profit. That's not where I want my medical dollars going. Remember that $3B is not going to an individual but mostly going to stock holders many of which may be pension plans, IRAs, etc. That money goes round and round. I'd rather see it going to the MDs responsbile for treating people.
A wise man is frequently humbled.
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Campfire 'Bwana
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Campfire 'Bwana
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Posts: 45,120 |
I have a graph that I show to people who complain about "the high cost of doctors" which shows the growth in total health care costs compared to the costs of doctors' fees and to the costs of administrators salaries. Administrators have skyrocketed in numbers and in salaries in the past 20 years, doctors have been almost stagnant in both areas. The reason health care costs so much today is that people who do nothing to deliver healthcare are taking over the system.
This is why 60 cents or more out of every health care dollar spent goes to administrative and regulatory costs. Bureaucracy.
The orthopedic surgeon who did my ankle recently said that he joined his practice in 2001 and since that time they've kept the same number of MDs, same number of support staff, and same number of patients. Today he's making less money, and we're all paying higher premiums. And the prior year United Health Care made a $3B profit. That's not where I want my medical dollars going. Remember that $3B is not going to an individual but mostly going to stock holders many of which may be pension plans, IRAs, etc. That money goes round and round. I'd rather see it going to the MDs responsbile for treating people. Bingo! Geno
The desert is a true treasure for him who seeks refuge from men and the evil of men.
In it is contentment
In it is death and all you seek
(Quoted from "The Bleeding of the Stone" Ibrahim Al-Koni)
member of the cabal of dysfunctional squirrels?
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Campfire 'Bwana
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Campfire 'Bwana
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They're the ones adding the kind of value I'm interested in.
A wise man is frequently humbled.
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Pharmacy Benefit Managers: Practices, Controversies, and What Lies Ahead
PBM–Pharmacy Contracts: The Spread and the Gag Clause
There have been controversies around how PBMs derive revenue from reimbursement to pharmacies. PBMs’ reimbursement to pharmacies for generic drugs has been based on a maximum allowable cost (MAC) schedule, a PBM-generated list of off-patent drugs that includes the maximum price the PBM will pay for each. The MAC schedule can be kept confidential from health plans, allowing PBMs to charge health plans and employers a higher price. The PBM then retains the difference between the MAC price they pay the pharmacy and the price the health plan pays, which is termed “the spread.” In a recent example of the pharmacy spread problem, two PBMs in Ohio reimbursed pharmacies $2.3 billion and billed Medicaid $2.5 billion for their generic and branded drugs, resulting in a spread of $200 million.a
Federal legislation proposed in 2017 and 2018 would mandate that PBMs update their MAC schedule to reflect generic drug price increases. This would likely protect pharmacies’ margins (especially for nonchain pharmacies that may not have large bargaining power), but would not address the problem of not knowing what share of the overall pharmacy spread is being passed on to payers, and ultimately patients. These reforms are also limited in that most of them only affect generic drug prices. To impact a larger share of overall drug spending, payers would need to calculate and recoup the spread made on both generic and brand-name drugs.
Another controversial issue is the gag clause, a requirement PBMs wrote into pharmacy contracts that prohibits pharmacists from disclosing to patients that a drug may be less expensive if paid for directly without using insurance. This allows PBMs to profit from patients’ copays. A recent JAMA study showed that copayments were higher than the cash price for one of four drugs purchased by patients with Medicare Part D insurance in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.b The gag clauses in the contract may directly stipulate that patients cannot be informed of the cheaper alternative unless they ask. In some cases, the contractual language may be more nebulous, with broad language requiring that pharmaceutical reimbursement rates and prices be kept confidential. States and Congress have taken swift action on gag clauses. Between 2016 and September 2018, 27 states enacted laws that sought to prevent gag clauses. In September 2018, Congress passed a federal law prohibiting gag clauses.
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I'd rather see it going to the MDs responsbile for treating people.
They're the ones adding the kind of value I'm interested in.
I understand what you are saying, but what company is going to hire these MDs without making a profit. It has become practically impossible for MDs to have a private practice, too much overhead.
Ed
A person who asks a question is a fool for 5 minutes the person who never asks is a fool forever.
The worst slaves are those that put the chains on themselves.
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