Healthcare - Stents

[Alan Klein]

Most of these people deal with billing which is incredibly complicated.  It's also a key reason why the US unlike other countries does not have an effective electronic medical records system (the VA is the one exception as their system is robust for the simple fact that they don't deal with billing issues).  All the ICD coding values focus on reimbursement rather than medical care and outcomes.  When I was at PhRMA we had a very big project that was designed to look at medical records for drug safety and outcomes.  Whole new vocabularies had to be designed to accomplish this and that work which began in 2008 is still going on.  Other countries can effectively identify adverse drug reactions and medical outcomes much faster than the US as their systems are outcome designed rather than payment designed.
This is just a silly statement.  Medicare really cares how much things cost and that's why their reimbursement rate is much lower than what private plans offer.  You also ignore the fact that private plans set up networks of hospitals and doctors who agree to set reimbursement fees.  We found this out the hard way some years ago when our excellent BlueCross plan would not fully reimburse the surgeon who did a gall bladder removal because she was not in network.

I agree Alan that one of the problems we have is multiple medical records.  Each group and hospital has its own system.  So it's hard for the patients   to remember who's got what and for doctors to get information from other systems.  ALso complicating it is the medical secrecy law to protect patients.  It adds so much extra paperwork.  Clerks need more sign offs to send medical records, insurance companies needs both spouses to sign off forms for each to handle the other insurance paperwork. 

ANother problem is just sending medical records.  Doctors refuse to use email so you can't attach records to them.   Only more difficult to handle fax or regular mail is allowed.  Another impediment to effective practices and requires more clerical work to be paid for to handle this extra work load.  The medical law regarding secrecy should be modified to add some common sense rules instead of these incredibly difficult time consuming and costly procedures or at least allow an opt out to streamline the process.  If I want to send my medical records or receive them by email, why should the government stop me? It's none of their business.

Regarding doctors who are not in insurance networks, doctors also opt out of Medicare.  I learned that the hard way when I went to one who I had to pay the entire bill for the visit out of pocket because he opted out.  Secondary insurance plans will not cover any of the bill if Medicare as primary does not accept the bill.  You're on Medicare like I am.  Be careful with that issue.  I always ask before I go to a new doctor if he or she accepts Medicare. 

[Alan Goldhammer]

Regarding doctors who are not in insurance networks, doctors also opt out of Medicare.  I learned that the hard way when I went to one who I had to pay the entire bill for the visit out of pocket because he opted out.  Secondary insurance plans will not cover any of the bill if Medicare as primary does not accept the bill.  You're on Medicare like I am.  Be careful with that issue.  I always ask before I go to a new doctor if he or she accepts Medicare.

A number of primary care docs are setting up concierge practices where one pays a large up front yearly fee.  This way they keep the practice size small and offer more rapid and personalized service.  That's the theory.  My primary care doc switched over to this starting this month and I didn't make the journey with him.  I think he was charging $1700/year/patient.  I don't know how much longer he will be practicing as he's 75 or so and he was a sole practitioner all the years I went to him.  He never took any insurance other than Medicare so I had to do all the paper work to get reimbursed.  All my doctors accept Medicare.

[Alan Klein]

A number of primary care docs are setting up concierge practices where one pays a large up front yearly fee.  This way they keep the practice size small and offer more rapid and personalized service.  That's the theory.  My primary care doc switched over to this starting this month and I didn't make the journey with him.  I think he was charging $1700/year/patient.  I don't know how much longer he will be practicing as he's 75 or so and he was a sole practitioner all the years I went to him.  He never took any insurance other than Medicare so I had to do all the paper work to get reimbursed.  All my doctors accept Medicare.

My sister before she died had concierge doctor in FLorida.  A lot of the people down there have it.  It's extra and not paid by Medicare.  The advantage was when she got sick with cancer, he acted as her coordinator with other doctors to make sure they were coordinating with each other.  he also showed up as times to look at her.  He got her admitted at hospital and smooth the way when a patient doesn;t have that power.  Your regular practitioner will not do those things usually.  A concierge is like your personal medical assistant.

Concierge is a good word.  It's like when you go to a hotel in a foreign city.  You ask them to make arrangements and get tickets for the theatre, or museums, or cab service, airline tickets, or whatever. Plus they tuck you in at night.

[PeterAit]

My sister before she died had concierge doctor in FLorida.  A lot of the people down there have it.  It's extra and not paid by Medicare.  The advantage was when she got sick with cancer, he acted as her coordinator with other doctors to make sure they were coordinating with each other.  he also showed up as times to look at her.  He got her admitted at hospital and smooth the way when a patient doesn;t have that power.  Your regular practitioner will not do those things usually.  A concierge is like your personal medical assistant.

Concierge is a good word.  It's like when you go to a hotel in a foreign city.  You ask them to make arrangements and get tickets for the theatre, or museums, or cab service, airline tickets, or whatever. Plus they tuck you in at night.

In my experience, true hotel concierges are a thing of the past--except perhaps for really high-end hotels (which I do not frequent). But medical concierge services can be great. We are members of Duke's (which they call Signature Care). The doc will spend as much time with you as needed and not rush things to get off to her next 15 min appointment. We can contact her by email at any time and get a quick response. We can ask her any medical question by email and she will answer. $2500 a year (each) but worth it even though neither of us has had any serious medical issues. As our doc said: "This is the way medicine should be practiced." But our system does not permit access to this kind of care to all those who cannot afford the fee.

[Alan Klein]

In my experience, true hotel concierges are a thing of the past--except perhaps for really high-end hotels (which I do not frequent). But medical concierge services can be great. We are members of Duke's (which they call Signature Care). The doc will spend as much time with you as needed and not rush things to get off to her next 15 min appointment. We can contact her by email at any time and get a quick response. We can ask her any medical question by email and she will answer. $2500 a year (each) but worth it even though neither of us has had any serious medical issues. As our doc said: "This is the way medicine should be practiced." But our system does not permit access to this kind of care to all those who cannot afford the fee.

If everyone in America had concierge services, it would cost $825 billion, more than the entire defense budget.  Even allowing for reduced rates, you're talking of immense costs.  Plus where do you find all the doctors to do this?  Be thankful you can afford it or are willing to sacrifice other things for it.  That's the way things work in a free society.  Other people would rather own a second  car or go on a vacation.  Everyone has a choice.  If our system forced everyone to have it, then people would not be free to choose how they want to live.  Freedom of choice is good.

[PeterAit]

If everyone in America had concierge services, it would cost $825 billion, more than the entire defense budget.  Even allowing for reduced rates, you're talking of immense costs.  Plus where do you find all the doctors to do this?  Be thankful you can afford it or are willing to sacrifice other things for it.  That's the way things work in a free society.  Other people would rather own a second  car or go on a vacation.  Everyone has a choice.  If our system forced everyone to have it, then people would not be free to choose how they want to live.  Freedom of choice is good.

 

As you say, concierge care for everyone is a pie-in-the-sky idea for many reasons. As for freedom of choice, I am all for it but am bothered by the fact that many people's freedom is severely limited by our economic system. Choosing between concierge care and second car is one thing, but choosing between the electric bill and your diabetes meds is another.

[Alan Klein]

 

As you say, concierge care for everyone is a pie-in-the-sky idea for many reasons. As for freedom of choice, I am all for it but am bothered by the fact that many people's freedom is severely limited by our economic system. Choosing between concierge care and second car is one thing, but choosing between the electric bill and your diabetes meds is another.

No one is suggesting that people die on the street.  Bu there's got to be a better way than going to a single payer government system.  There's already Medicare for people who can;t afford medicine.  Maybe that could be expanded.  But to do away with private medical care is dangerous and will hurt everyone in the end.  Private medical care with competition and many companies and services always is a better system.  It allows for choice, freedom, lower costs, better results, and more innovation.

[LesPalenik]

Well, the hospital stays for a day charged at $23,000 or $50,000 for a few days, as reported in another thread, is not a better system, it's a highway robbery.

[Alan Klein]

Medicare paid about quarter the charges for my bypass.  That worked out to around $7500 a day in the hospital for 13 days including Cardiac ICU, surgery, surgeon, nurses, medicine, pre-operative, post, etc.  So the $23,000 and $50,000 you mentioned seem rather high.  Of course, hospitals have schedules they cannot go over with medicare.  But I wouldn't pay their charges and let them sue where a court would pull back those numbers.  Just because people charge, doesn;t mean they are entitled to whatever they want.

If I was a foreigner, I'd tell them to come to my country to get my money or settle for a low amount.  They'll settle.    As a final thought, you could send the bill to Trump and ask him to take care of it.  He'll stick them with the whole thing.

[Alan Klein]

By the way, where I had the surgery at NY Presbyterian Hosp, it is the best heart hospital in NYC and the 2nd best in the country.  So a lot of other hospitals will charge a lot less depending where in the country you are.

[Craig Lamson]

Medicare paid about quarter the charges for my bypass.  That worked out to around $7500 a day in the hospital for 13 days including Cardiac ICU, surgery, surgeon, nurses, medicine, pre-operative, post, etc.  So the $23,000 and $50,000 you mentioned seem rather high.  Of course, hospitals have schedules they cannot go over with medicare.  But I wouldn't pay their charges and let them sue where a court would pull back those numbers.  Just because people charge, doesn;t mean they are entitled to whatever they want.

If I was a foreigner, I'd tell them to come to my country to get my money or settle for a low amount.  They'll settle.    As a final thought, you could send the bill to Trump and ask him to take care of it.  He'll stick them with the whole thing.

Just to be clear, it was 50K for ER visit, two days stay in the hospital, a trip the the surgical suite, than a another trip to surgury as an outpatient.  That figure also includes all the meds, DR time, and associated costs.  In the end everyone in this ordeal got to divy up only 12.k as paid by Medicare and my part b insurance policy.    I was billed nothing additional.  My point was Medicare only paid cents on the dollar of the hospital/DR bill. If that payment policy is extended to the entire US population it will destroy the medical profession in America as we currently know it.  At least IMO.

[KLaban]

I've recently spent over two weeks in hospital having had five endoscopy procedures including two surgical endoscopy under general anaesthetic. I also had a multitude of X-rays, several CT scans and many medications. Twelve days peeing into a bag and being fed with a nasal gastric tube. I had my own room with TV and Internet access and all of this as an National Health Service patient.

I'm thankful for our free-at-the-point-of-access NHS. I'm very grateful to all the consultants, doctors, dieticians, nursing and ancillary staff, many of whom are first, second or third generation immigrants from all corners of the world. The NHS - and indeed the care sector - relies on their compassionate care: long may we continue to attract and welcome such folk to the UK. 

[Rob C]

I've recently spent over two weeks in hospital having had five endoscopy procedures including two surgical endoscopy under general anaesthetic. I also had a multitude of X-rays, several CT scans and many medications. Twelve days peeing into a bag and being fed with a nasal gastric tube. I had my own room with TV and Internet access and all of this as an National Health Service patient.

I'm thankful for our free-at-the-point-of-access NHS. I'm very grateful to all the consultants, doctors, dieticians, nursing and ancillary staff, many of whom are first, second or third generation immigrants from all corners of the world. The NHS - and indeed the care sector - relies on their compassionate care: long may we continue to attract and welcome such folk to the UK.

My granddaughter told me that without foreign staff, our NHS would have to close. As a doctor in A&E, I believe she knows of what she speaks. They come from Spain, Greece, Egypt, India etc. etc. to give the UK a whirl.

And we had folks say "they come over here and steal our jobs..." If we could produce enough of our own - and keep them - there would be no need, but as life ain't a straight line, we need to be grateful for what we can still atttact.

And it's the same here on Mallorca: I have had docs from Morocco (one got me fixed up from my two heart attacks), from Cuba, from Argentina (for the irony lovers amongst us) and why? Because those people have internationally hot qualifications and they often use those skills to see the world, and I guess the Spanish deficit is also due to the fact that many of their guys are in Britain.

Were the extremists to get their way, those doors would close and Britain would become bereft of services because even if exceptions were made, why would those people come over knowing they might run into some idiot who takes exception to their accent?

[Rob C]

Just to be clear, it was 50K for ER visit, two days stay in the hospital, a trip the the surgical suite, than a another trip to surgury as an outpatient.  That figure also includes all the meds, DR time, and associated costs.  In the end everyone in this ordeal got to divy up only 12.k as paid by Medicare and my part b insurance policy.    I was billed nothing additional.  My point was Medicare only paid cents on the dollar of the hospital/DR bill. If that payment policy is extended to the entire US population it will destroy the medical profession in America as we currently know it.  At least IMO.

But why would it, how could it? America has the highest prices, so any state control could reduce those prices to those of any country at the next top level, which would represent a huge saving to your country. Your overpaid cats would have nowhere better to go, so they'd be obliged to stick around; after all, they live in the best country in the world, right, with the best political system, I'm told? For sure, with the best music.

Your hospital prices are so high because you pay yourselves so much. We pretty much all have great equipment these days; guess where lies the difference that makes your US patients' eyes bleed?

It's only the ingrained fear of governmental controls that prevent it; less fear and you could even stop your kids getting shot in school.

Rob

[Alan Klein]

America has a lot of Indian doctors here today.  Some are fine but I really don;t know how their qualifications compare to American trained doctors.  My surgeon was Japanese recommended by my cardiologist.  The other big thing going on is PA's - Physician Assistants.  They do all the preliminary workups now when you see the doctors.  EKG, temperature, heart pressure, history write ups, etc.  Then the doctor spend a few minutes with you and collects his fee that has been abbreviated by the government in Medicare, a sign of the future for all medical care.  These doctors have no problem working here in America.  They're getting rich.  What's to complain about?  Better than what they'll make in India. 

[Alan Klein]

But why would it, how could it? America has the highest prices, so any state control could reduce those prices to those of any country at the next top level, which would represent a huge saving to your country. Your overpaid cats would have nowhere better to go, so they'd be obliged to stick around; after all, they live in the best country in the world, right, with the best political system, I'm told? For sure, with the best music.

Your hospital prices are so high because you pay yourselves so much. We pretty much all have great equipment these days; guess where lies the difference that makes your US patients' eyes bleed?

It's only the ingrained fear of governmental controls that prevent it; less fear and you could even stop your kids getting shot in school.

Rob

The best people will drop out of Medicare and other government program.  Tat will leave them only for rich people who could afford them.  The rest of us will get the dregs.  If the government disallow opting out of government programs, than many great doctors will just retire or not go into medicine in the first place.  That will cut the heart out of better medical care. 

Money talks.  BS walks.

[armand]

What the hospital asks and what the insurance pays are unrelated things. Medicare in particular pays around 25-33% of the asking bill, which by itself is not really anchored in reality and the hospital knows it. Now, if you happen not to have insurance you get the same bill (or even higher in cases) but you don't have access to the lower rates, so it's a double strike: no insurance and asked to pay more. Usually those people can settle at some extent to closer to what the insurance would pay but even then it usually ends up being a lot of money. That's where the saying comes from, approx: you are one hospital bill away from bankruptcy.

[LesPalenik]

The best people will drop out of Medicare and other government program.  Tat will leave them only for rich people who could afford them.  The rest of us will get the dregs.  If the government disallow opting out of government programs, than many great doctors will just retire or not go into medicine in the first place.  That will cut the heart out of better medical care. 

Money talks.  BS walks.

I don't think that many good doctors would stop practicing medicine or starting driving a cab. Even at half their present rates the doctor jobs would still pay well. And if some less than competent doctors walk, no big loss.
 

[armand]

I don't think that many good doctors would stop practicing medicine or starting driving a cab. Even at half their present rates the doctor jobs would still pay well. And if some less than competent doctors walk, no big loss.

While there might be some truth in this I don't think it's that clear cut. Current US graduates have a significant debt to start with and currently there is a deficits of physicians overall (predicted to get worse), so if the number of physicians decreases, things aren't going to be better.
If US increases their US grads production (they won't, the bottleneck is not the number of med school spots but the residency spots) then there will be even more physicians anxious to pay their debt and looking mostly for the best paid spots.
Currently many of those "good doctors" are not overflowing with money, particularly the primary care. The deficit in primary care coverage is one the main reasons why US doesn't rank so well for its health system; prevention will always be cheaper and more effective than treatment.

[Alan Klein]

I don't think that many good doctors would stop practicing medicine or starting driving a cab. Even at half their present rates the doctor jobs would still pay well. And if some less than competent doctors walk, no big loss.
 

But the less competent ones will be the ones who stay.  A doctor who's been around a long time won't become a cab driver.  He'll just retire early. 

For those thinking about getting into the medical field, there're a lot of good paying jobs that require intelligent people to study.  Many will think, why should I go through 4 years of college, 3 years of medical school, internship, residence, work 16 hours a day, and all the huge expense I'll owe for my education just to get paid bupkis when I'm done?  They'll become lawyers and then politicians or CEO's or engineers or whatever.  Less qualified students will fill the slack in medical schools reducing the excellence of our medical industry.  Money talks, BS walks.