Free Birth Control; Children Up to 26; Pre-Existing Conditions; Free Mammograms, etc. If these matter to you...

[LucyStoner]

Yeah I really don't understand how this could actually save money.

 

Part of me realizes though that this does create jobs for people. So I also don't like the idea of taking jobs away either.

Because the doctor is being paid $180 an hour and the medical assistant is being paid $18 an hour. That's why it is cheaper to have the medical assistant do anything and everything that doesn't require someone with a higher level credential.

[TechWife]

I already addressed this.  So long as it is voluntary, do what you want.  The thing is the ACA itself  isn't voluntary.   So pardon my skepticism that any particular part will remain voluntary. 

 

You act like someone would be unable to get information on end of life decisions but for the ACA provision to pay for it.  This just isn't true. 

 

 

No, no I don't act like that. However, I am puzzled as to why you think physicians should not be paid for  counseling their patients through these very complex, difficult decisions. Information has long been available, what hasn't been available is a clear way to talk through the information with a trusted doctor. 

Edited January 15, 2017 by TechWife

[TechWife]

Not liking that this happened to you. Liking what you said about the difficulty. I'm sorry for all you and your family went through this fall. :grouphug:

 

Thank you. I needed the hug today! 

SaveSave

[TranquilMind]

No, no I don't act like that. However, I am puzzled as to why you think physicians should not be paid for the time they spend counseling their patients through these very complex, difficult decisions. Information has long been available, what hasn't been available is a clear way to talk through the information with a trusted doctor. 

They ARE being paid.   

 

Show me any doctor who spent a few minutes talking to a patient who didn't bill however he chose to code that meeting.

[TechWife]

They ARE being paid.   

 

Show me any doctor who spent a few minutes talking to a patient who didn't bill however he chose to code that meeting.

 

I have had a few appointments, most recently two weeks ago, where the physician didn't bill me because all he did was write a referral to a specialist.

 

When ds was in PICU, physicians from our regular pediatric practice checked on him daily. They never billed for that.   

 

An ethical physician will not falsify documentation in order to send a bill. They make every effort (actually, their staff makes the effort) to code correctly. It's a big deal. Prior to ACA, if a patient were to go to the physician only to discuss end of life care, that visit would not have been billable. Now it is. 

[Frances]

But doctors will talk to you any time you see them during the course of the care. They are still getting paid. They never see you without getting paid. They decide how to code it to accommodate the charge they want to make.

 

You act like they are doing anything free right now and the ACA needs to make special accommodation so they will get paid.

 

Watch someone die, and see how many suddenly swarm into your room - who have absolutely no role at the time - so they can put a final charge on the bill.

If you're talking about planning before you are ever in a situation to need the plan, then generally no, prior to changes with Medicare and the ACA, healthcare providers were not being reimbursed for this. If you listen to the Planet Money podcast I suggested, you will understand that the healthcare systems in LaCrosse absorbed the costs themselves because they thought it was worthwhile, even though they didn't get reimbursed for staff time and their revenues decreased due to fewer people choosing expensive interventions at the end of life.

 

There is a distinct difference between doctors talking to patients about these issues when someone is facing a serious diagnosis and healthy people making advanced plans about end of life decisions in consultation with a healthcare provider. The latter is what we are talking about here.

[TranquilMind]

I have had a few appointments, most recently two weeks ago, where the physician didn't bill me because all he did was write a referral to a specialist.

 

When ds was in PICU, physicians from our regular pediatric practice checked on him daily. They never billed for that.   

 

An ethical physician will not falsify documentation in order to send a bill. They make every effort (actually, their staff makes the effort) to code correctly. It's a big deal. Prior to ACA, if a patient were to go to the physician only to discuss end of life care, that visit would not have been billable. Now it is. 

 

They billed you in PICU, though it may not have been specifically delineated.  Their time to you wasn't free, though it may have been folded into another charge, with the doctor thinking, "Well, I see them about an hour a week, so I will bill for that in this charge.

 

I'm not saying it is unethical. I'm saying they have loads of options as to how to code that particular bill. 

Who makes and appointment and sees  a doctor ONLY to discuss some future issue?  Almost No one.  That would most likely happen while the person is there for another reason, particularly if battling an illness. 

 

Sure if someone sees you loads of times and only writes a referral that takes a few seconds, maybe you get a freebie on that one. 

 

 

Edited January 15, 2017 by TranquilMind

[TechWife]

They billed you in PICU, though it may not have been specifically delineated.  Their time to you wasn't free, though it may have been folded into another charge, with the doctor thinking, "Well, I see them about an hour a week, so I will bill for that in this charge.

 

I'm not saying it is unethical. I'm saying they have loads of options as to how to code that particular bill. 

Who makes and appointment and sees  a doctor ONLY to discuss some future issue?  Almost No one.  That would most likely happen while the person is there for another reason, particularly if battling an illness. 

 

Sure if someone sees you loads of times and only writes a referral that takes a few seconds, maybe you get a freebie on that one. 

 

No, they did not bill me. I read my bills very carefully. I read my EOB's very carefully. I am well aware of what I have and have not paid for. I know which doctors saw my son when he was in PICU and I know which doctors billed us when he was in PICU. When a physician hands me an encounter form with a zero in the charge column, I can assure you that I am not being billed. 

 

 

When you go to a doctor's appointment, you aren't paying a fee for their time. You are paying a fee for their expertise.  It is a fee for service, not an hourly rate. If it were an hourly rate, then your idea of folding into another visit would make financial sense for the doctor as they would get paid for their time. But, it isn't. You are billed for the particular type of service and expertise the doctor rendered during that particular visit. If they render end of life counseling, why should they not be paid for it? 

 

Whether or not people are in the practice of making an appointment to specifically discuss end of life care is irrelevant. There is a big difference in the amount of time you get with a doctor - sure you can bring it up when you're there for a sore throat and the doctor might spend a few minutes discussing this with you while all of the other patients wait.  At that point, the physician is getting reimbursed for the care of your sore throat, but they are not getting reimbursed for the time that they spent with you, off schedule, to discuss end of life care. With the ACA, they can get reimbursed for both the sick visit that took care of the sore throat and the expertise they used while  talking to you about end of life care. But just think, you could have gotten more of the doctors time and attention to talk about end of life care if you had made an appointment to do just that. Doctors parcel out their appointment times according to the complexity of the case, and you can bet they allow a lot more time for the end of life discussions than they do for the sore throats - if they know they are going to have them. 

Edited January 15, 2017 by TechWife

[SparklyUnicorn]

Because the doctor is being paid $180 an hour and the medical assistant is being paid $18 an hour. That's why it is cheaper to have the medical assistant do anything and everything that doesn't require someone with a higher level credential.

 

But the doctor is there the same amount of time.  So if the doctor is there 8 hours and the assistant is there 8 hours, does the doctor get paid for fewer hours? 

 

Not trying to be dense here.   In my experiences when the doctor is not in with the patient (all of a few minutes usually) he/she is sitting in their office.  They aren't constantly working with patients. 

I do think they need support staff.  I just think one assistant could assist two doctors, for example.  

 

When I took one of mine to an emergency clinic in Germany the doctor did everything except work the front desk.  She called in the patients.  She took down the info.  She did the minor procedures.  She didn't seem to have a problem with it and we got in very quickly.  Might have been luck, but it might also be that people don't need to use the ER for everyday stuff either. 

[AmandaVT]

But the doctor is there the same amount of time.  So if the doctor is there 8 hours and the assistant is there 8 hours, does the doctor get paid for fewer hours? 

 

Not trying to be dense here.   In my experiences when the doctor is not in with the patient (all of a few minutes usually) he/she is sitting in their office.  They aren't constantly working with patients. 

I do think they need support staff.  I just think one assistant could assist two doctors, for example.  

 

When I took one of mine to an emergency clinic in Germany the doctor did everything except work the front desk.  She called in the patients.  She took down the info.  She did the minor procedures.  She didn't seem to have a problem with it and we got in very quickly.  Might have been luck, but it might also be that people don't need to use the ER for everyday stuff either. 

 

Doctors get paid for specific codes. A pediatric well child visit is one code, an immunization given is another. Your kid comes in with a sniffly nose and cough? They can add a code for diagnosing rhinovirus. At least in the mental health field, the codes are time sensitive - if you see a client for 53 min vs. 54 min, you get paid differently. 

 

The assistant is there for an hourly wage or a salary. The Dr. (depending on the model of the office) most likely gets paid based on what he/she bills.

 

Therapists cannot bill for a telephone consult in my state. They cannot bill for speaking to the teachers or IEP team at a school for a client. They cannot bill insurance companies for their time doing paperwork (and it takes a lot of time). 

[SparklyUnicorn]

Doctors get paid for specific codes. A pediatric well child visit is one code, an immunization given is another. Your kid comes in with a sniffly nose and cough? They can add a code for diagnosing rhinovirus. At least in the mental health field, the codes are time sensitive - if you see a client for 53 min vs. 54 min, you get paid differently. 

 

The assistant is there for an hourly wage or a salary. The Dr. (depending on the model of the office) most likely gets paid based on what he/she bills.

 

Therapists cannot bill for a telephone consult in my state. They cannot bill for speaking to the teachers or IEP team at a school for a client. They cannot bill insurance companies for their time doing paperwork (and it takes a lot of time). 

 

No, that's not exactly true.  They usually get paid by one code based on overall complexity and time.  They can write down all those individual things they do, but that isn't how the contracts really tend to work.  They may get extra for more complicated procedures, but not for basic procedures.  So a new patient with a complex problem pays more than a follow up check up.  That sort of thing.  Doctors also rarely do vaccinations. 

[SparklyUnicorn]

There are some extras the doctor sometimes does that they don't get extra for.  Like the doctor called me with results on a physical last time I had one.  That is highly unusual though.  I've never had a doctor do that unless something was wrong.

 

 

[SparklyUnicorn]

But I suppose these assistants are NOT adding a ton to the cost. 

 

I just want to know what is up with hospitals that charge $100 for a Bandaid or aspirin.  Something is out of whack there.

 

 

Edited January 16, 2017 by SparklyUnicorn

[LucyStoner]

But the doctor is there the same amount of time. So if the doctor is there 8 hours and the assistant is there 8 hours, does the doctor get paid for fewer hours?

 

Not trying to be dense here. In my experiences when the doctor is not in with the patient (all of a few minutes usually) he/she is sitting in their office. They aren't constantly working with patients.

I do think they need support staff. I just think one assistant could assist two doctors, for example.

 

When I took one of mine to an emergency clinic in Germany the doctor did everything except work the front desk. She called in the patients. She took down the info. She did the minor procedures. She didn't seem to have a problem with it and we got in very quickly. Might have been luck, but it might also be that people don't need to use the ER for everyday stuff either.

The doctor can see more patients per hour if they are just walking from room to room and not be calling people back, taking their weight and other vitals etc.

 

Pretending that the $18 and $180 are the full costs of staffing in my example, 10 minutes with the medical assistant is $3 and 10 minutes with the doctor is $30.

 

In Germany the doctor makes a bit less money but the clinic is guaranteed payment and the system is totally different. I doubt doctors offices in Germany are struggling to fit in as many patients per hour as a lot of large clinics and HMOs are in the US.

 

Here, my ND does the whole visit from start to finish but she sees as few as 1-2 patients in an hour. That's not something most medical clinics are set up to do.

Edited January 16, 2017 by LucyStoner

[ktgrok]

But I suppose these assistance are adding a ton to the cost. 

 

I just want to know what is up with hospitals that charge $100 for a Bandaid or aspirin.  Something is out of whack there.

 

Two things. 

 

1. the guy in the next room that had a heart attack and needs critical care and then goes out and never pays his bill. His costs get distributed to everyone else. 

 

2. There is no way to put on your itemized bill "cost of paying several full time people to deal with over a dozen different insurance companies" not to mention "guy who cleans up the vomit in the waiting room" and "lady who scrubs the toilets". 

[SparklyUnicorn]

Two things. 

 

1. the guy in the next room that had a heart attack and needs critical care and then goes out and never pays his bill. His costs get distributed to everyone else. 

 

2. There is no way to put on your itemized bill "cost of paying several full time people to deal with over a dozen different insurance companies" not to mention "guy who cleans up the vomit in the waiting room" and "lady who scrubs the toilets". 

 

ack I worded that wrong...I meant NOT adding a ton to the cost...

[SparklyUnicorn]

Two things. 

 

1. the guy in the next room that had a heart attack and needs critical care and then goes out and never pays his bill. His costs get distributed to everyone else. 

 

2. There is no way to put on your itemized bill "cost of paying several full time people to deal with over a dozen different insurance companies" not to mention "guy who cleans up the vomit in the waiting room" and "lady who scrubs the toilets". 

 

But yes that makes sense.

[StephanieZ]

I'm not saying this. 

 

I think we as Americans will have to give up some of our frills and subsidize education for medical students.   I hate to be personal, but you've been very open about your recent surgery.  Should we as a country have to pay for your surgery as a group so that you can have another child?  I'm thinking it wasn't the main goal but your weight loss was a factor.  In a one payer system is this a frill or a necessity?  Again, I'm sorry to ask, but it's pertinent ( IMHO) to the discussion,  What are we as a nation able to provide to its citizens? 

 

WOW, how low can you go??? Really??

 

Katie's surgery and health care is not for you (or anyone!) to question or debate! WOW!!

 

I'm really nauseous that someone would say this. 

 

And, FTR, yes, yes, yes, we, as a nation, should pay for someone's surgery so they can be as healthy and as whole as possible. Certainly, for a young, fertile woman, being able to healthily bear children is an integral part of her health. I am pretty certain that every one on this board can relate to that!! I know I sure can!!! 

 

Unless a procedure is purely cosmetic/vanity related (i.e., face lift, boob job, butt lift, etc, that are not directly related to reconstruction or functional/health issues) -- those should remain out of publicly financed medicine (as they already are left off of insurance, etc.) . . . but beyond that, IMHO, our nation can and SHOULD and MUST provide health care for all our citizens. 

 

I am constantly shocked that so many good hearted people, who love God, who love Jesus, who focus much of their lives on religion and doing right by their families and others . . . do not rise up together and demand that our nation do the right thing by our people with respect to providing health care for all.

 

RISE UP!! Be the change!! Please, people, let's come together on this and make our nation a safe and healthy place for our children, and their children, to grow up and make their futures. 

Edited January 16, 2017 by StephanieZ

[ktgrok]

I should also add, my insurance didn't cover my surgery out of the goodness of their heart. It's because it has been proven to be less costly to them to pay for the surgery than to pay for the kinds of health problems that continued obesity causes. And that surgery is the most effective treatment for obesity. They did it because it costs them less in the long run, not because they care what size my jeans are. 

[heartlikealion]

Yeah, just on the flip side, it frustrates me to no end that I would have to pay for maternity care I don't want and can't use (because, um, hello, infertility) till I'm in my 50's just because some politician decides everyone MUST have it.

 

There really is room for more opinions. If people want policies with that stuff, let them buy it. Those of us who don't use any of that don't want to.

 

But thanks for the update. I agree, things are being done so quickly, it's hard to keep up, whether you agree with the changes or not! 

 

I'm sorry that you got stuck paying for stuff you didn't want/can't use. I had the opposite problem a couple years ago. I thought my plan covered maternity, but it didn't. I had to pay a lot out of pocket for my initial ob/gyn visit because the alternative was to postpone the visit several weeks before my new plan kicked in and I was uncomfortable doing that.

 

Edited January 16, 2017 by heartlikealion

[Lang Syne Boardie]

WOW, how low can you go??? Really??

 

Katie's surgery and health care is not for you (or anyone!) to question or debate! WOW!!

 

I'm really nauseous that someone would say this. 

 

 

Wow. I missed that post.

 

Truth is, Katie is also paying for our health-restoring surgeries and medications.

 

She's not a pauper on the street, with her cane and her little tin cup, begging passers-by for bariatric surgery.

 

Neither is anyone coming into our house and stealing our money, to give to Katie's surgeon.

 

We're all paying taxes. We're all paying something for health care.

 

There is this libertarian mean streak that I keep encountering lately; public education is the other arena. "End public education. Stop stealing my money for other people's kids. I take care of mine. Now you take care of yours." Now in health care, "I should decide whether my taxes pay for other people's health care."

 

As if every man is an island. Oh, wait, "sovereign" is the preferred term.

 

As if we don't all end up paying a lot more, in myriad ways, when children and sick people go without education and healthcare.

 

As if every sovereign citizen does not benefit from our nation's infrastructure in a million tiny ways, every day - the infrastructure that required ALL of us to build.

 

As if we're not a community, a family, a nation, a race. A single race, called mankind.

 

As if the "government" is anything other than us.

 

We have people who have health care pronouncing on the excesses of government-instigated health care for those who would otherwise have none, and will have none if the nation doesn't work together.

 

We have people who attended public schools and universities complaining about property tax and income tax percentages going to support public schools.

 

The ONLY thing I appreciate about these perspectives is that those who hold them are finally speaking them more plainly - I like to know up front what I'm dealing with, before I try to work with such folks in my community. I mean, spare me. Save me the time.

 

 

 

 

[NoPlaceLikeHome]

No, no I don't act like that. However, I am puzzled as to why you think physicians should not be paid for  counseling their patients through these very complex, difficult decisions. Information has long been available, what hasn't been available is a clear way to talk through the information with a trusted doctor. 

I agree doctors should have a way of being paid for end of life decisions counseling. Let us not forget that a patient never has to have this counseling as well if they choose not too and that they can say I want everything humanly possible done for me and don't pull the plug! My father wants this and it is his choice and ACA or the government does not take away that choice.

 

 

I have not read all replies yet so excuse me if I am being redundant.

[SKL]

NM excuse me for being busy working and not posting until page 17.  Goodbye.

Edited January 16, 2017 by SKL

[Barb_]

They did not end it, they voted to enable the Congress to change it to something that works better.

 

Nobody is indifferent to pre-existing conditions etc. There is only disagreement on how best to address them.

Oh please. Pot stirring. This is page 17.

[AmandaVT]

So, I forgot to mention this in my earlier posts, but VT is trying something new with healthcare. It's called the All Payer model. It's been rushed through by the governor that just left office, so I don't know a ton about it yet. 

 

From what I gather, though, health care providers will get paid a lump sum, yearly, to care for their patients. If patients stay healthy and don't need as many visits, the providers will be receiving more money per visit essentially. If the patients are less healthy and need more care, the Dr's have already been compensated and provide that care from the money they've received.

 

Here's the overview: http://gmcboard.vermont.gov/sites/gmcb/files/documents/payment-reform/APM_Draft_Agreement_One_Page.pdf

 

We have no idea how it's going to work if it's going to work, but the people involved in drafting the bill, seem excited. Many are skeptical (including me) because of how and who rammed this through. The last governor was not popular at all and Democrats and Republicans in the state very happily voted in a Republican as our new governor. 

[Barb_]

So, I forgot to mention this in my earlier posts, but VT is trying something new with healthcare. It's called the All Payer model. It's been rushed through by the governor that just left office, so I don't know a ton about it yet.

 

From what I gather, though, health care providers will get paid a lump sum, yearly, to care for their patients. If patients stay healthy and don't need as many visits, the providers will be receiving more money per visit essentially. If the patients are less healthy and need more care, the Dr's have already been compensated and provide that care from the money they've received.

 

Here's the overview: http://gmcboard.vermont.gov/sites/gmcb/files/documents/payment-reform/APM_Draft_Agreement_One_Page.pdf

 

We have no idea how it's going to work if it's going to work, but the people involved in drafting the bill, seem excited. Many are skeptical (including me) because of how and who rammed this through. The last governor was not popular at all and Democrats and Republicans in the state very happily voted in a Republican as our new governor.

I'm a little confused as to how that will work, but hey, it's something different!

[Frances]

So, I forgot to mention this in my earlier posts, but VT is trying something new with healthcare. It's called the All Payer model. It's been rushed through by the governor that just left office, so I don't know a ton about it yet.

 

From what I gather, though, health care providers will get paid a lump sum, yearly, to care for their patients. If patients stay healthy and don't need as many visits, the providers will be receiving more money per visit essentially. If the patients are less healthy and need more care, the Dr's have already been compensated and provide that care from the money they've received.

 

Here's the overview: http://gmcboard.vermont.gov/sites/gmcb/files/documents/payment-reform/APM_Draft_Agreement_One_Page.pdf

 

We have no idea how it's going to work if it's going to work, but the people involved in drafting the bill, seem excited. Many are skeptical (including me) because of how and who rammed this through. The last governor was not popular at all and Democrats and Republicans in the state very happily voted in a Republican as our new governor.

I believe the coordinated care organizations that were formed in my state to handle the large influx of new Medicaid patients after the ACA passed do something like this.

[Guest]

 

There is this libertarian mean streak that I keep encountering lately; public education is the other arena. "End public education. Stop stealing my money for other people's kids. I take care of mine. Now you take care of yours." Now in health care, "I should decide whether my taxes pay for other people's health care."

 

.

Around here,.those thoughts come from.the people who received the short end of the stick. Higher premiums and deductible so high that they end up not getting anything the entire year paid for by the insurance, and it sums up to 3 to 5k more than pre-ACA oop.. Then they have to listen to stories about how their money has been.redistributed to capable nonworkers who have self inflicted issues such as diabetes. That grates them so much they speak out. They would.rather hear their money went to vets, or children.

 

The school.district is the same. Their children are not.being given instruction, just review..and their pocketbooks are so light from paying school tax that they can't afford private or home school. Of course they are upset. School is supposed to be a place of learning for everyone. They are being ripped off and called racist or elitist if they object to their kid sitting in multiple Study halls. They want votech and college prep returned.

 

These are the excluded deplorables. They pay, And get zero in return.

Edited January 16, 2017 by Heigh Ho

[AmandaVT]

I'm a little confused as to how that will work, but hey, it's something different!

 

We are too. I believe it's a 5-year test run and providers will be able to opt in to the plan at this point. I like some of the thoughts behind it, but I am not sure how well it's going to work. I really wish that they didn't ram it through so quickly. 

 

Our new governor has some ideas about making a New England health care coalition. He's been reaching out to the governors of other New England states, both Dem and Rep. I haven't heard specifics yet (shocker from a politician, I know!) but I'm hoping he's got something. He knows what a mess our state's exchange is and he seems committed to fixing it. 

[AmandaVT]

Around here,.those thoughts come from.the people who received the short end of the stick. Higher premiums and deductible so high that they end up not getting anything the entire year paid for by the insurance, and it sums up to 3 to 5k more than pre-ACA oop.. Then they have to listen to stories about how their money has been.redistributed to capable nonworkers who have self inflicted issues such as diabetes. That grates them so much they speak out. They would.rather hear their money went to vets, or children.

 

The school.district is the same. Their children are not.being given instruction, just review..and their pocketbooks are so light from paying school tax that they can't afford private or home school. Of course they are upset. School is supposed to be a place of learning for everyone. They are being ripped off and called racist or elitist if they object to their kid sitting in multiple Study halls. They want votech and college prep returned.

 

At risk of derailing the thread, I hate how schools propose budget increases to our towns. We had a school budget amendment a couple of years ago that was a "school facility improvement" measure. I have no problem with keeping up school facilities, but this one was ridiculous. They wanted some crazy amount like $5 million, to replace the roof and upgrade the kitchen area and library. Our local school is tiny, less than 100 kids. When voters questioned the cost, they were told that they didn't care about their kids' education. Then, within months, they needed more money because the first $5 million just wasn't enough. There's no way that project should have cost that much - it's really not that big a building. 

 

Sorry, had to vent for a minute. Our property taxes went up by about $500 because of that darn budget.

[Artichoke]

WOW, how low can you go??? Really??

 

Katie's surgery and health care is not for you (or anyone!) to question or debate! WOW!!

 

I'm really nauseous that someone would say this. 

 

And, FTR, yes, yes, yes, we, as a nation, should pay for someone's surgery so they can be as healthy and as whole as possible. Certainly, for a young, fertile woman, being able to healthily bear children is an integral part of her health. I am pretty certain that every one on this board can relate to that!! I know I sure can!!! 

 

Unless a procedure is purely cosmetic/vanity related (i.e., face lift, boob job, butt lift, etc, that are not directly related to reconstruction or functional/health issues) -- those should remain out of publicly financed medicine (as they already are left off of insurance, etc.) . . . but beyond that, IMHO, our nation can and SHOULD and MUST provide health care for all our citizens. 

 

I am constantly shocked that so many good hearted people, who love God, who love Jesus, who focus much of their lives on religion and doing right by their families and others . . . do not rise up together and demand that our nation do the right thing by our people with respect to providing health care for all.

 

RISE UP!! Be the change!! Please, people, let's come together on this and make our nation a safe and healthy place for our children, and their children, to grow up and make their futures. 

 

I wasn't trying to go low as you put it or attack Katie.    

 

To Katie, I absolutely apologize if it came across as attacking or not agreeing with your medical choices.  That wasn't my intent at all.   You have been so open about your medical procedures on the boards that it came to mind as we discussed healthcare.  Again, my apologies. 

[TechWife]

 

 

Not trying to be dense here.   In my experiences when the doctor is not in with the patient (all of a few minutes usually) he/she is sitting in their office.  They aren't constantly working with patients. 

I do think they need support staff.  I just think one assistant could assist two doctors, for example.  

 

 

When the doctor is sitting in their office, they are doing paperwork for insurance companies, signing off on prescription refills and reviewing lab results, among other things. Just because they are not physically with a patient doesn't mean they aren't doing patient related work. There are things only a doctor can do (signature required, for example). In that case, it would be a waste of resources to have the doctor doing the work an assistant could do, because the doctor's paperwork, etc. would still be there for him at the end of the day. In addition, doctors in private practice must work on the business of being a private practice. That is also work an assistant can't do. 

 

So, if you take a doctors' work and say he makes $150/hour, an assistant $15/hour:

10 hours of doctor = $1500

8 ours of assistant = $120

 

or if there is no assistant and the doctor has to put in more hours: 

14 hours of doctor = $2100 

It saves the practice money if the assistant is there to do the work. In this lame example, it would save $480. Over a month, that's $9,600.00 

 

The example has some flaws - Doctors in private practice are salaried, but even then you can calculate a "per hour" cost to the practice of having a physician do tasks as opposed to an assistant do tasks. It is pretty much a constant fact that the business would save money if the tasks are completed by the lowest paid person possible. This is why there are CNA's, pharmacy techs, medical assistants, PT, OT and ST assistants and so on. Since increased costs are passed along to the patient, using allied health professionals saves everyone money. 

[ktgrok]

I wasn't trying to go low as you put it or attack Katie.    

 

To Katie, I absolutely apologize if it came across as attacking or not agreeing with your medical choices.  That wasn't my intent at all.   You have been so open about your medical procedures on the boards that it came to mind as we discussed healthcare.  Again, my apologies. 

 

It's fine. i'm the one who was open about it, so I agree, fair game. 

 

And it's a valid question, as to what is and isn't covered - no matter what the system. Is it cosmetic, or is it medical? Preventative, treatment, or something else?

[TechWife]

 

2. There is no way to put on your itemized bill "cost of paying several full time people to deal with over a dozen different insurance companies" not to mention "guy who cleans up the vomit in the waiting room" and "lady who scrubs the toilets". 

 

Not to mention the supply clerks, pharmacy techs, pharmacists, pneumatic tube system that carries the medications to the unit, the RN that brings it to the room, the person who empires the trash of all of the packaging materials, the computer that is used to document the aspirin. None of those things are billed for individually. The cost has to be rolled in. And yes, they are all there because they are helping the hospital comply with one regulation or another (documentation, timeliness of delivery, licensing requirements, sanitation standards, it goes on and on). 

[ktgrok]

I also want to be clear that I don't begrudge anyone the health care, or the discounts, or whatever, that they have been able to get. Be that medical sharing, charitable programs, medicaid, or out of pocket. 

 

I have pointed out some problems with many of those models, not because I am against anyone using them, but because I don't think they will work for everyone, and I'm looking for a solution that does work for everyone. 

 

Arctic Mama in specific, I didn't mean to say you shouldn't do what you did, or that it isn't the best solution for your family right now. Just that as a model for everyone it won't work. 

[purplejackmama]

It's fine. i'm the one who was open about it, so I agree, fair game.

 

And it's a valid question, as to what is and isn't covered - no matter what the system. Is it cosmetic, or is it medical? Preventative, treatment, or something else?

And it's infuriating that the same procedures are covered by some companies but not others. My BCBS friend just paid OOP for her gastric bypass surgery because they do not cover bariatric surgeries.

[TechWife]

So, I forgot to mention this in my earlier posts, but VT is trying something new with healthcare. It's called the All Payer model. It's been rushed through by the governor that just left office, so I don't know a ton about it yet. 

 

From what I gather, though, health care providers will get paid a lump sum, yearly, to care for their patients. If patients stay healthy and don't need as many visits, the providers will be receiving more money per visit essentially. If the patients are less healthy and need more care, the Dr's have already been compensated and provide that care from the money they've received.

 

 

This reminds me of what we call "Capitation fees" - the fee the provider receives is capped and if they have an unhealthy patient population, they loose money like a leaky faucet. It's a big gamble. 

[Carol in Cal.]

This reminds me of what we call "Capitation fees" - the fee the provider receives is capped and if they have an unhealthy patient population, they loose money like a leaky faucet. It's a big gamble. 

Yup.

The Medicare Advantage programs are like this.

Not all of them are sticking around.  And the last I knew, the law was unclear as to whether someone can move into a standard Medigap plan without underwriting if the Med. Advantage plan is too restrictive or just not a good fit.

[displace]

But the doctor is there the same amount of time. So if the doctor is there 8 hours and the assistant is there 8 hours, does the doctor get paid for fewer hours?

 

Not trying to be dense here. In my experiences when the doctor is not in with the patient (all of a few minutes usually) he/she is sitting in their office. They aren't constantly working with patients.

I do think they need support staff. I just think one assistant could assist two doctors, for example.

 

When I took one of mine to an emergency clinic in Germany the doctor did everything except work the front desk. She called in the patients. She took down the info. She did the minor procedures. She didn't seem to have a problem with it and we got in very quickly. Might have been luck, but it might also be that people don't need to use the ER for everyday stuff either.

Doctors in the US work an average of 60 hours per week. That's only an average. They spend hours doing paperwork daily. Most have no breaks and work at home at night and the weekends, not to mention being on call.

 

The average patient time slot is 15-20 min per patient (general practitioner).

 

An ER clinic is different. But definition it was for emergencies. ERs work by triage system. If no one is there and it's a slow day, the doctor may do everything. A GP at a busy clinic can't do it all. Without doing it all they still put in 12 hr days every day of the week.

[SparklyUnicorn]

Doctors in the US work an average of 60 hours per week. That's only an average. They spend hours doing paperwork daily. Most have no breaks and work at home at night and the weekends, not to mention being on call.

 

The average patient time slot is 15-20 min per patient (general practitioner).

 

An ER clinic is different. But definition it was for emergencies. ERs work by triage system. If no one is there and it's a slow day, the doctor may do everything. A GP at a busy clinic can't do it all. Without doing it all they still put in 12 hr days every day of the week.

 

Yeah I know.  I worked in doctor's offices.  I suppose I should have mentioned that.  I just think in all cases of what I saw, they had a lot of redundant and excessive amounts of support staff.  For many days I spent a lot of time not doing much of anything.  Some office were definitely busier than others and needed that number of staff (OBGYN was one in particular). 

 

I can't say much about the ER clinic because this was in another country.

[Lanny]

Pharmaceutical companies in the USA are raising drug prices 18% every year?  They may be facing some resistance very soon. They have incredibly powerful lobbyists in Washington DC.   The video interview on this URL was quite interesting. http://www.foxnews.com/politics/2017/01/16/trump-reportedly-insists-healthcare-replacement-will-have-insurance-for-everybody.html

 

[lauraw4321]

They ARE being paid.

 

Show me any doctor who spent a few minutes talking to a patient who didn't bill however he chose to code that meeting.

My BFF. She bills ethically. Which means she often does not get paid for her time. Example - in a physical code, you aren't supposed to talk about ailments. Of course that's never the way it works. So she's supposed to bill extra codes. But she has patients who can't afford that (i.e. The physical is covered, nothing else) so she does the extra work, takes the extra time, and doesn't bill for it.

[TranquilMind]

My BFF. She bills ethically. Which means she often does not get paid for her time. Example - in a physical code, you aren't supposed to talk about ailments. Of course that's never the way it works. So she's supposed to bill extra codes. But she has patients who can't afford that (i.e. The physical is covered, nothing else) so she does the extra work, takes the extra time, and doesn't bill for it.

Well, good for her.  Glad to hear that one exists.  I'm sure there are some, but most have to just charge every code they can to cover their expenses of the huge bureaucracy required to manage all the paperwork. 

[historically accurate]

Well, good for her.  Glad to hear that one exists.  I'm sure there are some, but most have to just charge every code they can to cover their expenses of the huge bureaucracy required to manage all the paperwork. 

 

It's not illegal or unethical in any way for a doctor to bill for their time. They work for a paycheck just like anyone else. Now, if they were overbilling, that's another story (and I hope that's not what you're implying the majority of doctors are doing).

[TranquilMind]

It's not illegal or unethical in any way for a doctor to bill for their time. They work for a paycheck just like anyone else. Now, if they were overbilling, that's another story (and I hope that's not what you're implying the majority of doctors are doing).

 

That is not what I said.

I merely said they ARE getting paid for their time, with which you agree, since you say they work for a paycheck. 

 

[Barb_]

It's not illegal or unethical in any way for a doctor to bill for their time. They work for a paycheck just like anyone else. Now, if they were overbilling, that's another story (and I hope that's not what you're implying the majority of doctors are doing).

Some doctors are a huge pain and there is really no way to qualify for a free yearly physical. Our plan allows for a free physical, but I had a doctor that would code the thing differently if you opened your mouth about anything. You have seasonal allergies, here is a prescription, no free physical for you. He also insisted on seeing my teenaged daughter every three months for her Ritalin renewal instead of onc or twice a year. And he insisted on coding for a high level psych eval instead of a meds renewal check even though it amounted to, "Are you still doing ok on these? How do you find friends when you're homeschooling? What does it feel like when you don't take your meds?" That's pretty much it.

 

So a gray area, but when I explained that BCBS had kicked out the last two bills because they cover mental health codes differently (preauthorizations, etc), he refused to code it with a medical code that would be covered. I got the feeling I was being milked for cash.

 

We left the practice over that, btw and found one who codes fairly. Unfortunately their front office staff comes from the bowels of hell so I avoid doctors as much as I can when we're in AZ. My doctors' offices in IL are light years better.

Edited January 16, 2017 by Barb_

[historically accurate]

That is not what I said.

I merely said they ARE getting paid for their time, with which you agree, since you say they work for a paycheck. 

 

Sorry for the misunderstanding. It sounded like you were happy that pp's friend wasn't billing everything. Now that I read again, I see how you are giving kudos for the charity and then explaining how most can't do that, rather than saying more should do that.

[TranquilMind]

Sorry for the misunderstanding. It sounded like you were happy that pp's friend wasn't billing everything. Now that I read again, I see how you are giving kudos for the charity and then explaining how most can't do that, rather than saying more should do that.

 

More should do that. 

 

 

[TranquilMind]

Some doctors are a huge pain and there is really no way to qualify for a free yearly physical. Our plan allows for a free physical, but I had a doctor that would code the thing differently if you opened your mouth about anything. You have seasonal allergies, here is a prescription, no free physical for you. He also insisted on seeing my teenaged daughter every three months for her Ritalin renewal instead of onc or twice a year. And he insisted on coding for a high level psych eval instead of a meds renewal check even though it amounted to, "Are you still doing ok on these? How do you find friends when you're homeschooling? What does it feel like when you don't take your meds?" That's pretty much it.

 

So a gray area, but when I explained that BCBS had kicked out the last two bills because they cover mental health codes differently (preauthorizations, etc), he refused to code it with a medical code that would be covered. I got the feeling I was being milked for cash.

I'm sorry that happened to you. 

 

We have a good one that will even code the free wellness exam as such.  Of course, we don't really talk about other issues, but I've known this guy over 30 years, so I could if I had to, I think. 

Edited January 16, 2017 by TranquilMind

[SparklyUnicorn]

Some doctors are a huge pain and there is really no way to qualify for a free yearly physical. Our plan allows for a free physical, but I had a doctor that would code the thing differently if you opened your mouth about anything. You have seasonal allergies, here is a prescription, no free physical for you. He also insisted on seeing my teenaged daughter every three months for her Ritalin renewal instead of onc or twice a year. And he insisted on coding for a high level psych eval instead of a meds renewal check even though it amounted to, "Are you still doing ok on these? How do you find friends when you're homeschooling? What does it feel like when you don't take your meds?" That's pretty much it.

 

So a gray area, but when I explained that BCBS had kicked out the last two bills because they cover mental health codes differently (preauthorizations, etc), he refused to code it with a medical code that would be covered. I got the feeling I was being milked for cash.

 

Oh yeah some are like this.  We fought one doctor on him billing for an office visit on top of a physical visit.  He charged for an office visit on top of it because during the physical he said to my husband, "Do you have any health concerns?" And my husband said he has a lot of heartburn.  To which the doctor said stop drinking soda (my husband rarely drinks soda).  That was literally it.  We did "win" when we challenged it.