"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!
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.
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."
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.
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.
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.
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.)
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.
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.
"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!
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.
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."
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.
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.
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.
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.)
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
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.