"Intense coding practices in Medicare Advantage" sounds like doctors diagnosing for the optimal Medicare code, the code that will yield the most revenue and profit. The covid bonuses have already trained health care to do that.
it doesn't end well, that's for sure. right now, while you still can, find a medical practice that doesn't take insurance. i am on medicare but i only use if if i have to (hit by car, etc). for my normal medical care, i go to an out of pocket practice where the people have the same ethics i have. i keep myself healthy. any e-mails i get from medicare to remind me about my vaccines, my mammograms and all the other unnecessary tests and shots, get thrown in the virtual trash
The patient is only a pawn for the greedy (hospitals, doctors, insurers and Pharma) to take from the stupid (government health and human services). The patient "experience" has deteriorated to the point where the attending healthcare person, doctor or nurse, spends 80% of the time looking at a computer screen and has virtually no eye contact with the patient. Medical histories are recorded and rerecorded and diagnostic codes are complete mysteries to the patient. Hundreds of e-mails, text messages and never a phone call from a doctor anymore. And Canada is offering assisted suicide as a viable "heath care" option. Can we be far behind? Is there a code for that? Again, thank you Chris for following the money!
While generally I never argue when someone calls the government stupid, in this case I think that they are getting what they are paying for. They are buying control of our medical information and decisions as a step in the process of making us pharma controlled cattle. In this situation we are the plankton, the pharma companies are the shrimp that eat us and the government is the whale that scoops them up.
After two years of Jabmania can anyone doubt that control by drugs is the Deep State's endgame? So go get some anti-depressants, a few statins, and another jab and shut up.
It's a messed up system. The regulations change every few years. The profitable has to fund the unprofitable - if Medicare reimburses an X procedure at way more than the time it takes and Y at below cost, then even with the best intentions you will be minimaxing and trying to generate revenue here to cover shortfalls there.
Also, the legislation stating with ACA favors consolidation very explicitly, and it's easier to contract with giant corporate entities than individual offices. Of course everything gets corporatized, even without the additional financial incentive discussed here.
One last thing, is that the government money can be a poison pill. It comes with so many strings attached that companies with the apparent capabilities might exit the market because the requirements are too onerous, which could be viewed as a saving grace from the state's totalizing control, in a way.
It will all crash eventually, but not until all the wealth is drained.
Learn to be as self sufficient as possible and teach your kids and grandkids to do the same, including your own medical care. Learn the medicinal herbs right in your back yard, take a CPR class, get a first aid manual and learn it. Read about real nutrition ( meat and fat are food, plants are medicine), exercise, vitamins and minerals, sunshine, grounding. There are many other healing modalities like traditional Chinese medicine, Ayurvedic, acupuncture, homeopathy, etc. Stay away from the deathcare system as much as possible. Your life depends on it.
Don, that's almost word for word what my Grandmother said - about sixty years ago! She didn't have much use for the medical profession. Eventually, of course, she died. At 96. And was never "sick" a day in her long and productive life.
Dont’ forget the back door, in which the corporations then send millions back to the politicians. It’s an endless loop of corporations lobby and in many cases write the legislation that lawmakers pass, spending trillions on boondoggles that actually make things worse and create more problems that require more money for the same failed solutions. The corporations then take a portion of the profit and send it back to the same politicians. The fed provided cheap money to the banks at 0% for over a decade, bank account deposits became irrelevant so the banks customer is now the government. So they all work together to keep the game going. How long will we tolerate this as a people?
At the end of the day, what's the real difference between a Soviet command economy, where the government orders industry to do its bidding by law, and a globohomo American "capitalist" economy where government is industry's biggest (by far) customer and orders industry around because "the customer's always right?" We just took a different road to the same destination. Turns out, to borrow a phrase from today's political class, that Barry Goldwater was on the "right side of history."
I was just thinking, it ends with the collapse of the Federal Government and most of their corporate patrons, ala the Soviet Union. A great weight will be lifted...
Most of the Founder's constitutional safeguards have been eroded or outright demolished, but the existence of seperates states with some remaining scraps of the autonomy they were originally given may well be what saves us. The currency (that mother lf all ponzi schemes) is the source of almost all the federal government's (illegitimate) power now. Once that goes, it's over. The states can pick up the pieces and try again.
Close. The currency is just a scam to get the real things of value. States need to reclaim their LAND from the federal government, and control of natural(aka real) resources then let the Washingtards do whatever they want with their paper crap.
Russia, China, the Saudis and most of the rest of the world have realised our paper is only good for wiping your ass with. The American people need to catch up.
The way I put is that once the fake economy of printing money and handing it out the connected overtakes the real economy of voluntary transactions, the wheels come off the bus.
I think we passed that point a few years ago, and there's nothing left to do but watch "them" inflate away the value of our labor and savings.
Yeah. We see how our financial economy is doing since it decided to take on a resource and manufacturing based economy(Russia). Turns out having a high GDP that is 75% CEO salaries and paying to put ads on youtube doesn't really mean that much when bullets start flying.
The pols know it. That is why they are just openly funneling the money from the treasury, through Ukraine and crapto into their pockets. The davos crowd is exactly the same as their footsoldiers looting foot locker. It's all the same.
Note that this is a purely administrative function. I studied ICD-9 back in 2003. and the administrative state supporting it. Doctors need to be told how much time to spend, exam suggestions etc. to maximize billing.
I had a drunken dinner with a cardiologist, a few years ago, who said that if you had Medicare and you came to his office, you were getting an EKG. He said there was never any question about whether or not you needed one, but it was purely a function of the fact that Medicare would ALWAYS pay for an EKG, no questions asked. It would be interesting to get a window into all of those gimmicks.
In my limited experience, EKGs are administered like candy.
Coding is a vital component of day-to-day operations in any hospital or medical establishment. Errors result in at least a month's delay in compensation. The first thing they do is teach you the tricks to maximize billing. It's a business like any other, and there is no compassion involved.
Here in the UK with its failing socialised medical system the aim is to do fewer expensive tests and as those require long waiting periods, there’s always the hope for natural attrition first.
They do like blood tests but then as few of the General practitioners understand them, the patient must learn how to interpret them. Or else suffer the consequences.
Like hypothyroid for over a decade!! TSH was going up and up from a baseline low and it took pre-surgery scan to notice it.
Keep records of your blood results to monitor changes. Just because it’s in a normal range doesn’t mean it’s normal for you. Plot the changes.
You must become your own doctor and assess when a consultant is required. Because in the NHS they’ll do everything to stop you accessing good quality care.
Are government bounties to hospitals for producing dead Covid patients (we'll look the other way while you complete the paperwork) the new model of "healthcare?" What would the pandemic have looked like if hospitals had been incentivized instead to save patients? Crazy thought. Just remember, Soylent Green is people.
I've always thought wistfully of the (possibly apocryphal?) story that ancient Chinese doctors got paid ONLY WHILE THEIR PATIENT WAS HEALTHY. As soon as that patient got sick, the money stopped.
Can you even imagine how that would scuttle, and ultimately revolutionize, health care?
It's been this way for awhile. A few years ago, a neurologist friend explained to a group of us that the insurance and Medicare/Medicaid coding requirements have doctors completely hamstrung. In order to get paid, doctors/nurses are required to give and record results for several varying tests--depending on what they're trying to diagnose.
If a test result or range is ____, then they are REQUIRED to prescribe _____ and/or _____. And if it's ____, there might also be a need for follow-up tests, lab work, scans, etc. (Even if the doctor doesn't think it is necessary or will help; or worse, might affect or be affected by other drugs the patient is currently taking.) And there has to be a paper trail to show the prescription or further test recommendation was made. That's why many times, the doctor (or "primary care physician" office) will make all the necessary arrangements for you. It's taken care of, pre-coded and set up so that everyone can bill from the file on the visit.
It's also what ensures they get PAID--and why "good medical billers with coding experience" are both in demand and highly paid. Yes, you read that right. If certain dictated "rules" are not followed--many of which involve prescriptions--the insurance company or Medicare/Medicaid might not pay for the visit. Even worse, your 2 year old's checkup? The doctor makes on average about $400 just to administer a vaccine cocktail that's approved by the CDC and FDA--and is implied is mandatory. Basically from birth, our doctors are both required and incentivized to pump poisons into all of us to, uhm, "get paid."
Those of us listening to the doctor's recap were all shocked at what he was telling us. He added that he--and could only speak for himself--felt is was always in the patient's best interest that if he doubted the effectiveness when he was required to give them a prescription, he'd personally tell them, "I am required by the government (or your insurance company) to write you this prescription based on your test results or they may not pay for the visit. By writing it, I have performed my duty to them in order to get your visit today paid for--but cannot say I necessarily agree with it. Therefore, I will leave it up to you on whether to fill or take the prescription."
I've shared that story with several other former doctors and nurses since--and every single one nodded their head in agreement. A few even admitted that's one of the underlying reasons they retired or left all together.
Only a couple of weeks after the neurologist told us that, I had to have an emergency cataract surgery. My eye doctor was not only a friend from church, but in my "preferred provider network." He diagnosed it on Friday and they set up the surgery for the following Wednesday afternoon. Late Monday, I got a call from my doctor's office saying there was a problem with my insurance preauthorization, so I needed to call them. Turns out the "doctor" and his primary office practice were in the network, but the outpatient surgery center he used was not. LSS, if I had the operation in his office, the surgery would be covered. However, if I had it done at the surgery center, it would not be covered and I would have to pay for it all out of pocket, including the doctor's fee! I was furious, but had no choice. I worked with the doctor and the surgery center to make arrangements to pay as "uninsured"--and that meant I had to pay the surgery center by check or credit card on arrival for the surgery. No billing--it was no payment, no surgery.
Interestingly enough, about 4pm on Tuesday before the Wednesday surgery, the lady I spoke with at the insurance company called to see if I was still having the surgery. When I told her that I was making arrangements directly, she told me to contact the manager of the surgery center and give the manager her direct line--perhaps they could work out an "acceptable one-time deal" to have it covered by my "insurance." By now I could see that if it went through insurance it would cost me even more, but they'd be cut in on the deal--and that's all she wanted.
I'll admit that what I told her she could do with that one-time deal wasn't very nice. (Oh, and I haven't been to a doctor since.)
Been through a similar situation when we had our first colonoscopy. All arranged through our gastroenterologist, and I specifically talked to the billing person in his office about it all being covered and was assured we were good to go. Turns out the place we had the procedure done was partially owned by our Gastroentrologist; which ended up NOT being in our network. Boy, we were hoppin’ mad over that. The person at our insurance company I was having conversations with about the bill taught me a valuable lesson. She said ultimately it’s our responsibility to make sure about the in-network coverage by speaking to the insurer directly. I felt so empowered! 🙄
We also learned that day that if they find anything as a result of the colonoscopy and have to take some biopsies for testing, that your colonoscopy procedure is not covered the same way as if they find nothing. It costs you more out of pocket for the procedure in addition to the cost of the tests. Also things we were not informed about till after the fact. Because, why not literally bend you over and you have to take?
Despite all of this past history and my once again speaking to the insurer ahead of time, when my husband recently went to go get his second one, it turned out the anesthesia was not part of the covered expenses, and the doctors who did the procedure was not in network at the in network practice. I did learn about the doctor not being in the same tier ahead of time and husband didn’t want to change things after it was already scheduled so we bit the bullet on that one. But not covering anesthesia was a new twist.
I’m convinced they make it very difficult to sort out what is covered and what isn’t by design. And you never find out till after the fact! It makes zero sense to set up a healthcare system this way unless the goal is to squeeze more money out of people.
And for those young enough to not remember: It was NEVER this way until Obamacare was forced upon us--totally UNREAD and passed in the middle of the night by his political party on a straight party line vote.
I do remember how having health insurance coverage meant you were actually covered. Those days are long gone.
We also used to see Doctors who owned their own practices. Most are now part of some type of corporation. And that is accelerating. Amazon now wants to provide my healthcare? Because I matter to them. They told me so in an email and with a banner at the top of my Amazon account main page!
We live in the era of Potemkin Prosperity. It's all the facade of growth with none of the actual work, with the result that everything gets increasingly fake and gay and rapidly catty as we squabble over the diminishing pile of actual resources while collectively pretending the pie is getting bigger instead of disappearing down globohomomegacorp's digital gullet.
"In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse."
I know there was one study that was based in Vermont (was it this one? Don't know. In the Dartmouth Alumni mag, maybe). They found that people with more local health care facilities used them much more, but were no healthier than people out in the country who didn't have the same access to facilities.
As a NP my primary focus is the patient. For a short time I worked at a CVS Minute Clinic. Many patients we treated had no insurance - so when I prescribed I made sure to send them to a pharmacy that could give the meds free or very cheap. I was reprimanded- told to direct them to CVS. Not only that- CVS actually sent a memo out to all the NP’s telling us we were not to suggest any pharmacy except CVS. I was stunned they were actually brazen enough to put it in writing. My answer to that was that “I am a pt advocate- period. That is my #1 job”. I did not keep my job for long- no big loss.
The only obvious, and long term solution to his problem is that the care givers (doc networks, hospitals, outpatient services, etc) must also own the underwriting risk. Kaiser Permanente of California and Geisinger of Pennsylvania are two examples. Having said that, these two “non-profits” are highly profitable, pay no taxes and pay themselves a fortune. Employers and, to a lesser degree, employees, are footing the bill. There is still insufficient political will to blow up the tax exempt world, and make them pay taxes, or force them to reduce prices. The “for profit” world ends up raising prices such that the tax exempts can draft off of them.
I suspect the only real solution is in a culture of resolute honesty and integrity, which means that there is no solution. My understanding of the Kaiser model, with no personal experience or direct knowledge, is that it turns doctors into button-pushing script followers who enter data and then do what the protocol says. I can't prove that.
Daughter was with Kaiser through her work. All fine till she became pregnant for the second time in the age of COVID, and then one of the nurse practitioners began relentlessly pushing her to get the shot while pregnant, and actually told her she didn’t want to see another pregnant women die because they didn’t get the vaccine.
I thank God my daughter has more sense than to be intimidated by these scare tactics. She switched who she was seeing and they dropped it. She was told she had to wear a mask while delivering the baby by one autocratic nurse, but a different one told her not to bother. Now, since the CDC so thoughtfully added the Covid jab to the childhood vaccination schedule, they began pestering her to get both her little ones jabbed. So she has now dropped Kaiser to make that go away.
My fear though is that it looks like they will attempt to close off all areas of self-autonomy again, but even more so. The looming specter of CBDC and the UBI, and
the WHO Pandemic treaty about to be signed off on by Biden are concerning. Hubs and I both think they will likely tie having whatever shots GovInc dictates to being able to get your SS benefits and/or Medicare too.
I think you are right on both points. When I was growing up, we had the idea of Marcus Welby, M.D. on television. Talk about earnest! I think the vast majority of images of doctors were, as you say, of resolute honesty and integrity.
Something changed. I offer the following theory: the top of the intellectual strata, given the choice of going for the “money” in a Wall Street job, corporate law, McKinsey consultant, etc. looked a lot better than being a general practitioner making a meager $150k per year and making middle of the night house calls. Then, the big money “specialist” emerged, and medicine was a place to get rich. This is where we are today - the almighty dollar is crowding out the integrity. To your point, not a lot of hope for a solution.
"Intense coding practices in Medicare Advantage" sounds like doctors diagnosing for the optimal Medicare code, the code that will yield the most revenue and profit. The covid bonuses have already trained health care to do that.
it doesn't end well, that's for sure. right now, while you still can, find a medical practice that doesn't take insurance. i am on medicare but i only use if if i have to (hit by car, etc). for my normal medical care, i go to an out of pocket practice where the people have the same ethics i have. i keep myself healthy. any e-mails i get from medicare to remind me about my vaccines, my mammograms and all the other unnecessary tests and shots, get thrown in the virtual trash
The patient is only a pawn for the greedy (hospitals, doctors, insurers and Pharma) to take from the stupid (government health and human services). The patient "experience" has deteriorated to the point where the attending healthcare person, doctor or nurse, spends 80% of the time looking at a computer screen and has virtually no eye contact with the patient. Medical histories are recorded and rerecorded and diagnostic codes are complete mysteries to the patient. Hundreds of e-mails, text messages and never a phone call from a doctor anymore. And Canada is offering assisted suicide as a viable "heath care" option. Can we be far behind? Is there a code for that? Again, thank you Chris for following the money!
While generally I never argue when someone calls the government stupid, in this case I think that they are getting what they are paying for. They are buying control of our medical information and decisions as a step in the process of making us pharma controlled cattle. In this situation we are the plankton, the pharma companies are the shrimp that eat us and the government is the whale that scoops them up.
After two years of Jabmania can anyone doubt that control by drugs is the Deep State's endgame? So go get some anti-depressants, a few statins, and another jab and shut up.
And it's our money in the first place! But you are right : we have the power to change it
It's a messed up system. The regulations change every few years. The profitable has to fund the unprofitable - if Medicare reimburses an X procedure at way more than the time it takes and Y at below cost, then even with the best intentions you will be minimaxing and trying to generate revenue here to cover shortfalls there.
Also, the legislation stating with ACA favors consolidation very explicitly, and it's easier to contract with giant corporate entities than individual offices. Of course everything gets corporatized, even without the additional financial incentive discussed here.
One last thing, is that the government money can be a poison pill. It comes with so many strings attached that companies with the apparent capabilities might exit the market because the requirements are too onerous, which could be viewed as a saving grace from the state's totalizing control, in a way.
It will all crash eventually, but not until all the wealth is drained.
Learn to be as self sufficient as possible and teach your kids and grandkids to do the same, including your own medical care. Learn the medicinal herbs right in your back yard, take a CPR class, get a first aid manual and learn it. Read about real nutrition ( meat and fat are food, plants are medicine), exercise, vitamins and minerals, sunshine, grounding. There are many other healing modalities like traditional Chinese medicine, Ayurvedic, acupuncture, homeopathy, etc. Stay away from the deathcare system as much as possible. Your life depends on it.
Don, that's almost word for word what my Grandmother said - about sixty years ago! She didn't have much use for the medical profession. Eventually, of course, she died. At 96. And was never "sick" a day in her long and productive life.
Wise woman. Did she write anything down?
Sadly, no. Gran believed strongly in "render unto Caesar" and that in return, "Caesar should keep it's long pointed nose out of my affairs".
Dont’ forget the back door, in which the corporations then send millions back to the politicians. It’s an endless loop of corporations lobby and in many cases write the legislation that lawmakers pass, spending trillions on boondoggles that actually make things worse and create more problems that require more money for the same failed solutions. The corporations then take a portion of the profit and send it back to the same politicians. The fed provided cheap money to the banks at 0% for over a decade, bank account deposits became irrelevant so the banks customer is now the government. So they all work together to keep the game going. How long will we tolerate this as a people?
At the end of the day, what's the real difference between a Soviet command economy, where the government orders industry to do its bidding by law, and a globohomo American "capitalist" economy where government is industry's biggest (by far) customer and orders industry around because "the customer's always right?" We just took a different road to the same destination. Turns out, to borrow a phrase from today's political class, that Barry Goldwater was on the "right side of history."
I was just thinking, it ends with the collapse of the Federal Government and most of their corporate patrons, ala the Soviet Union. A great weight will be lifted...
Most of the Founder's constitutional safeguards have been eroded or outright demolished, but the existence of seperates states with some remaining scraps of the autonomy they were originally given may well be what saves us. The currency (that mother lf all ponzi schemes) is the source of almost all the federal government's (illegitimate) power now. Once that goes, it's over. The states can pick up the pieces and try again.
Close. The currency is just a scam to get the real things of value. States need to reclaim their LAND from the federal government, and control of natural(aka real) resources then let the Washingtards do whatever they want with their paper crap.
Russia, China, the Saudis and most of the rest of the world have realised our paper is only good for wiping your ass with. The American people need to catch up.
AuH2O. 👍
A chemist who knows his political history has joined the chat!
😁
What was that Mussolini quote about fascism: “Everything for the state, nothing outside the state, nothing above the state"
spending going parabolic to collapse into CBDC
all the 🐷 at the trough before the source dries up
“Tell Me How This Ends.”
----------
The way I put is that once the fake economy of printing money and handing it out the connected overtakes the real economy of voluntary transactions, the wheels come off the bus.
I think we passed that point a few years ago, and there's nothing left to do but watch "them" inflate away the value of our labor and savings.
Yeah. We see how our financial economy is doing since it decided to take on a resource and manufacturing based economy(Russia). Turns out having a high GDP that is 75% CEO salaries and paying to put ads on youtube doesn't really mean that much when bullets start flying.
The pols know it. That is why they are just openly funneling the money from the treasury, through Ukraine and crapto into their pockets. The davos crowd is exactly the same as their footsoldiers looting foot locker. It's all the same.
not sure if foot locker still exists. might be showing my age
Note that this is a purely administrative function. I studied ICD-9 back in 2003. and the administrative state supporting it. Doctors need to be told how much time to spend, exam suggestions etc. to maximize billing.
I had a drunken dinner with a cardiologist, a few years ago, who said that if you had Medicare and you came to his office, you were getting an EKG. He said there was never any question about whether or not you needed one, but it was purely a function of the fact that Medicare would ALWAYS pay for an EKG, no questions asked. It would be interesting to get a window into all of those gimmicks.
In my limited experience, EKGs are administered like candy.
Coding is a vital component of day-to-day operations in any hospital or medical establishment. Errors result in at least a month's delay in compensation. The first thing they do is teach you the tricks to maximize billing. It's a business like any other, and there is no compassion involved.
Here in the UK with its failing socialised medical system the aim is to do fewer expensive tests and as those require long waiting periods, there’s always the hope for natural attrition first.
They do like blood tests but then as few of the General practitioners understand them, the patient must learn how to interpret them. Or else suffer the consequences.
Like hypothyroid for over a decade!! TSH was going up and up from a baseline low and it took pre-surgery scan to notice it.
Keep records of your blood results to monitor changes. Just because it’s in a normal range doesn’t mean it’s normal for you. Plot the changes.
You must become your own doctor and assess when a consultant is required. Because in the NHS they’ll do everything to stop you accessing good quality care.
Emergencies like car accidents, NHS ✅
Chronic conditions 🛑
Are government bounties to hospitals for producing dead Covid patients (we'll look the other way while you complete the paperwork) the new model of "healthcare?" What would the pandemic have looked like if hospitals had been incentivized instead to save patients? Crazy thought. Just remember, Soylent Green is people.
Incentivize hospitals to save patients!?!?!? That's crazy talk!
I've always thought wistfully of the (possibly apocryphal?) story that ancient Chinese doctors got paid ONLY WHILE THEIR PATIENT WAS HEALTHY. As soon as that patient got sick, the money stopped.
Can you even imagine how that would scuttle, and ultimately revolutionize, health care?
It's been this way for awhile. A few years ago, a neurologist friend explained to a group of us that the insurance and Medicare/Medicaid coding requirements have doctors completely hamstrung. In order to get paid, doctors/nurses are required to give and record results for several varying tests--depending on what they're trying to diagnose.
If a test result or range is ____, then they are REQUIRED to prescribe _____ and/or _____. And if it's ____, there might also be a need for follow-up tests, lab work, scans, etc. (Even if the doctor doesn't think it is necessary or will help; or worse, might affect or be affected by other drugs the patient is currently taking.) And there has to be a paper trail to show the prescription or further test recommendation was made. That's why many times, the doctor (or "primary care physician" office) will make all the necessary arrangements for you. It's taken care of, pre-coded and set up so that everyone can bill from the file on the visit.
It's also what ensures they get PAID--and why "good medical billers with coding experience" are both in demand and highly paid. Yes, you read that right. If certain dictated "rules" are not followed--many of which involve prescriptions--the insurance company or Medicare/Medicaid might not pay for the visit. Even worse, your 2 year old's checkup? The doctor makes on average about $400 just to administer a vaccine cocktail that's approved by the CDC and FDA--and is implied is mandatory. Basically from birth, our doctors are both required and incentivized to pump poisons into all of us to, uhm, "get paid."
Those of us listening to the doctor's recap were all shocked at what he was telling us. He added that he--and could only speak for himself--felt is was always in the patient's best interest that if he doubted the effectiveness when he was required to give them a prescription, he'd personally tell them, "I am required by the government (or your insurance company) to write you this prescription based on your test results or they may not pay for the visit. By writing it, I have performed my duty to them in order to get your visit today paid for--but cannot say I necessarily agree with it. Therefore, I will leave it up to you on whether to fill or take the prescription."
I've shared that story with several other former doctors and nurses since--and every single one nodded their head in agreement. A few even admitted that's one of the underlying reasons they retired or left all together.
Only a couple of weeks after the neurologist told us that, I had to have an emergency cataract surgery. My eye doctor was not only a friend from church, but in my "preferred provider network." He diagnosed it on Friday and they set up the surgery for the following Wednesday afternoon. Late Monday, I got a call from my doctor's office saying there was a problem with my insurance preauthorization, so I needed to call them. Turns out the "doctor" and his primary office practice were in the network, but the outpatient surgery center he used was not. LSS, if I had the operation in his office, the surgery would be covered. However, if I had it done at the surgery center, it would not be covered and I would have to pay for it all out of pocket, including the doctor's fee! I was furious, but had no choice. I worked with the doctor and the surgery center to make arrangements to pay as "uninsured"--and that meant I had to pay the surgery center by check or credit card on arrival for the surgery. No billing--it was no payment, no surgery.
Interestingly enough, about 4pm on Tuesday before the Wednesday surgery, the lady I spoke with at the insurance company called to see if I was still having the surgery. When I told her that I was making arrangements directly, she told me to contact the manager of the surgery center and give the manager her direct line--perhaps they could work out an "acceptable one-time deal" to have it covered by my "insurance." By now I could see that if it went through insurance it would cost me even more, but they'd be cut in on the deal--and that's all she wanted.
I'll admit that what I told her she could do with that one-time deal wasn't very nice. (Oh, and I haven't been to a doctor since.)
Been through a similar situation when we had our first colonoscopy. All arranged through our gastroenterologist, and I specifically talked to the billing person in his office about it all being covered and was assured we were good to go. Turns out the place we had the procedure done was partially owned by our Gastroentrologist; which ended up NOT being in our network. Boy, we were hoppin’ mad over that. The person at our insurance company I was having conversations with about the bill taught me a valuable lesson. She said ultimately it’s our responsibility to make sure about the in-network coverage by speaking to the insurer directly. I felt so empowered! 🙄
We also learned that day that if they find anything as a result of the colonoscopy and have to take some biopsies for testing, that your colonoscopy procedure is not covered the same way as if they find nothing. It costs you more out of pocket for the procedure in addition to the cost of the tests. Also things we were not informed about till after the fact. Because, why not literally bend you over and you have to take?
Despite all of this past history and my once again speaking to the insurer ahead of time, when my husband recently went to go get his second one, it turned out the anesthesia was not part of the covered expenses, and the doctors who did the procedure was not in network at the in network practice. I did learn about the doctor not being in the same tier ahead of time and husband didn’t want to change things after it was already scheduled so we bit the bullet on that one. But not covering anesthesia was a new twist.
I’m convinced they make it very difficult to sort out what is covered and what isn’t by design. And you never find out till after the fact! It makes zero sense to set up a healthcare system this way unless the goal is to squeeze more money out of people.
And for those young enough to not remember: It was NEVER this way until Obamacare was forced upon us--totally UNREAD and passed in the middle of the night by his political party on a straight party line vote.
I do remember how having health insurance coverage meant you were actually covered. Those days are long gone.
We also used to see Doctors who owned their own practices. Most are now part of some type of corporation. And that is accelerating. Amazon now wants to provide my healthcare? Because I matter to them. They told me so in an email and with a banner at the top of my Amazon account main page!
We live in the era of Potemkin Prosperity. It's all the facade of growth with none of the actual work, with the result that everything gets increasingly fake and gay and rapidly catty as we squabble over the diminishing pile of actual resources while collectively pretending the pie is getting bigger instead of disappearing down globohomomegacorp's digital gullet.
Chris. Check out one of the seminal articles on this subject from 2009 by Atul Gawande. Fascinating and horrifying
https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum
"In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse."
I know there was one study that was based in Vermont (was it this one? Don't know. In the Dartmouth Alumni mag, maybe). They found that people with more local health care facilities used them much more, but were no healthier than people out in the country who didn't have the same access to facilities.
Roemer’s Law
That doesn't surprise me in the least. Sadly.
The New Yorker will not allow me to read this, the bastards. I'll try to open it with other browsers.
Got it. What a depressing thing to read.
As a NP my primary focus is the patient. For a short time I worked at a CVS Minute Clinic. Many patients we treated had no insurance - so when I prescribed I made sure to send them to a pharmacy that could give the meds free or very cheap. I was reprimanded- told to direct them to CVS. Not only that- CVS actually sent a memo out to all the NP’s telling us we were not to suggest any pharmacy except CVS. I was stunned they were actually brazen enough to put it in writing. My answer to that was that “I am a pt advocate- period. That is my #1 job”. I did not keep my job for long- no big loss.
Depressingly, not a surprise at all.
The only obvious, and long term solution to his problem is that the care givers (doc networks, hospitals, outpatient services, etc) must also own the underwriting risk. Kaiser Permanente of California and Geisinger of Pennsylvania are two examples. Having said that, these two “non-profits” are highly profitable, pay no taxes and pay themselves a fortune. Employers and, to a lesser degree, employees, are footing the bill. There is still insufficient political will to blow up the tax exempt world, and make them pay taxes, or force them to reduce prices. The “for profit” world ends up raising prices such that the tax exempts can draft off of them.
I suspect the only real solution is in a culture of resolute honesty and integrity, which means that there is no solution. My understanding of the Kaiser model, with no personal experience or direct knowledge, is that it turns doctors into button-pushing script followers who enter data and then do what the protocol says. I can't prove that.
Daughter was with Kaiser through her work. All fine till she became pregnant for the second time in the age of COVID, and then one of the nurse practitioners began relentlessly pushing her to get the shot while pregnant, and actually told her she didn’t want to see another pregnant women die because they didn’t get the vaccine.
I thank God my daughter has more sense than to be intimidated by these scare tactics. She switched who she was seeing and they dropped it. She was told she had to wear a mask while delivering the baby by one autocratic nurse, but a different one told her not to bother. Now, since the CDC so thoughtfully added the Covid jab to the childhood vaccination schedule, they began pestering her to get both her little ones jabbed. So she has now dropped Kaiser to make that go away.
My fear though is that it looks like they will attempt to close off all areas of self-autonomy again, but even more so. The looming specter of CBDC and the UBI, and
the WHO Pandemic treaty about to be signed off on by Biden are concerning. Hubs and I both think they will likely tie having whatever shots GovInc dictates to being able to get your SS benefits and/or Medicare too.
I think you are right on both points. When I was growing up, we had the idea of Marcus Welby, M.D. on television. Talk about earnest! I think the vast majority of images of doctors were, as you say, of resolute honesty and integrity.
Something changed. I offer the following theory: the top of the intellectual strata, given the choice of going for the “money” in a Wall Street job, corporate law, McKinsey consultant, etc. looked a lot better than being a general practitioner making a meager $150k per year and making middle of the night house calls. Then, the big money “specialist” emerged, and medicine was a place to get rich. This is where we are today - the almighty dollar is crowding out the integrity. To your point, not a lot of hope for a solution.