KillHour posted:

I can't believe we live in a timeline where the "Free medication coupons!" app is legit and NOT using it is the scam.

Republicans posted:

Sounds like a magic window into what healthcare costs could be like if our entire medical insurance industry wasn't a scam.

Crashrat posted:

To that end I think the athenahealth solution would be better. There's definitely something to be said about the OpenEMR system, but I'm afraid the lack of polish will just cause headaches. The fact that OpenEMR's wiki still reads like it was written for IT people, rather than for staff, just makes me more leery.

The Phlegmatist posted:

If you're not actually billing anyone and you need to train the staff to use the EMR system in their workflow anyway then I don't really see why OpenEMR wouldn't work. I don't have any personal experience with it but, uh...all EMR systems are varying levels of lovely.

I have doubts that a bunch of open source developers could keep up with HHS's insanity though, so if you're billing Medicare you'd likely run into problems with MIPS next year.

Crashrat posted:

The hard part is transitioning to OpenEMR. Almost ALL of their lab records are on paper that were uploaded as PDFs to Practice Fusion. Nothing was entered as structured data or pulled electronically. I have absolutely no idea how to pull that from Practice Fusion in any way except manually one-by-one.

svenkatesh posted:

I can speak with certainty about Epic - (I'm simplifying here) they only sell to mid-size and large-hospitals, with some notable exceptions.

That doesn't mean that you can't use Epic. It means you'll have to talk to an area hospital that's on Epic to see if you can partner with them under the "Community Connect" program.

Feel free to PM me if you have specific questions.

quote:

Because although HB 897 threatens to end Medicaid benefits for hundreds of thousands living elsewhere in the state, it includes exemptions for people who live in counties with an unemployment rate of more than 8.5%, like the ones Schmidt represents.

Live in Detroit? You're out of luck.

The city's unemployment rate is higher than 8.5%, but the unemployment rate in surrounding Wayne County is just 5.5% — meaning Detroiters living in poverty, with a dysfunctional transit system that makes it harder to reach good-paying jobs, won't qualify for that exemption. The same is true in Flint and the state's other struggling cities.

Get that? Rural residents of up-north counties with high unemployment are protected; urban Michiganders who live in high-unemployment cities in more prosperous counties are left to twist.

...

The bill's Senate sponsors admit that this proposal isn't about saving money; in fact, it'll cost about $30 million a year to administer the program.

It's pitched, instead, as a firm-but-gentle hand to those who've become dependent on the teat of government dependency. In the benevolent scenario articulated to Lansing news service Gongwer by GOP lawmakers like Shirkey and Senate Majority Leader Arlan Meekhof (R-West Olive), it's a push toward the path of self-sufficiency, and insurance that the state has the resources to help those who really need it.

quote:

I quit their system and closed my office. Even though the data is owned by you, they will give the data free, but you can't read it at all. When you ask them how to decode the files under their format, they said it is up to your own IT people to figure it out. If you want them to give you PDF format, they want $5000 per provider to get your data/charts in readable format and charge you $500 for the hard drive that is only worth $70-80 (2TB Western Digital drive). You had to choose a closing date.

jit bull transpile posted:

Do this. I've worked for a few emr vendors and epic is by far the least bad. There's gotta be at least one local hospital with an outreach program that would community connect you in.

Avalanche posted:

EClinicalWorks can suck my cock.

quote:

High-deductible plans have become commonplace, a deterrent used by companies to lower health care costs by discouraging unnecessary tests or treatments. Evidence for that link has mounted since the Great Recession 10 years ago, when deductibles began to soar: People increasingly deferred medical care, putting off elective surgeries and doctors’ visits. National health care spending slowed as a result.

But a recent study of women with insurance plans that carried deductibles of at least $1,000 underscores the danger to consumers required to shoulder a greater share of those costs.

Women who had just learned they had breast cancer were more likely to delay getting care if their deductibles were high, the study showed. A review of several years of medical claims exposed a pattern: Women confronting such immediate expenses put off getting diagnostic imaging and biopsies, postponing treatment.

And they delayed beginning chemotherapy by an average of seven months, said Dr. J. Frank Wharam, a Harvard researcher and one of the authors of the study, published earlier this year in the Journal of Clinical Oncology.

“Slight delays added up to long delays,” Dr. Wharam said.

While the study did not look at how the women fared after treatment, cancer doctors warn that even short gaps between diagnosis and treatment can affect the outcome. Survival rates are higher for patients with some cancers if they are treated early.

“What we see here is an unintended consequence of sharing costs,” said Dr. Ethan Basch, the director of cancer outcomes research at UNC Lineberger Comprehensive Cancer Center, who was not involved in the study.

quote:

About half of all covered workers in the United States are now enrolled in plans with a deductible of at least $1,000, and many must pay several thousand dollars in medical bills before their plans even start to cover their care. About 11 percent of covered workers have a deductible of at least $3,000, according to a survey of employer benefits by the Kaiser Family Foundation. Employers are increasingly offering these plans — and more frequently giving their workers no other option.

While high-deductible plans are meant to encourage people to think twice about whether a test or treatment is necessary and if it can be done at a lower price, “it’s also frankly to impede their use of these services,” said Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center.

The plans are succeeding in reducing the use of care. “The question is, at what cost?” Dr. Bach said.
High-deductible plans pose a problem, say researchers who have studied them, because patients do not always distinguish between the care they should get and what they can do without.

***

Two years ago, when Rochelle Ness was 37, with three children under 6 years old, she learned she had breast cancer. The policy she had through her husband’s job had a deductible of $2,250 and required she pay a total of $11,500 toward her yearly medical bills.

She did not know how she would come up with the money, but having lost two family members to breast cancer, she did not consider delaying treatment. “That was scarier to me,” she said.

Now saddled with medical debt, Ms. Ness is also fighting to get her insurer to pay for the six Neulasta injections needed to help prevent infections during chemotherapy.

Her husband’s employer did not offer a savings account to accompany the high-deductible plan, and they still owe about $25,000. “We have maxed out our credit cards trying to pay medical expenses,” she said.

Ms. Ness, who received financial assistance from the Samfund, said she is now trying to come up with the money for additional treatments, including physical therapy and a hearing aid for the hearing loss resulting from chemotherapy.

Living paycheck to paycheck, the family is struggling to find any extra money to pay for their children to go camping or join a sports team.

“We were able to manage our medical bills back then,” she said. “It’s nearly impossible right now.”

Willa Rogers posted:

More proof that the "bending of the cost curve" is due to high deductibles that result in people deferring diagnosis & treatment:


"unintended," lol. The insurance industry had wanted high deductibles for forever before it was given the chance to write them into the ACA.

Avalanche posted:

RisqueBarber posted:

Don't go to the ER unless it's an absolute emergency, like your bleeding out or are having a heart attack.

hobbesmaster posted:

Lay people are not qualified to make that determination and if they call someone educated like say a nurse's line for liability reasons they will almost always so to go to the ER.

hobbesmaster posted:

Lay people are not qualified to make that determination and if they call someone educated like say a nurse's line for liability reasons they will almost always so to go to the ER.

Azhais posted:

I could have multiple gunshot wounds and I'd drag my bloody carcass to an urgent care before risking the expense of the ER. You know, in case it wasn't actually that bad.

ERs desperately need reform

Avalanche posted:

I wonder how much of a self-fulfilling prophecy high deductible plans are in terms of driving up expenses for insurers. Doesn't it make more financial sense to keep people healthy and alive for as long as you possibly can?

Peven Stan posted:

For large group employer plans the insurer is actually your company and aetna etc. are just the people who handle the paperwork

Reik posted:

Not when the majority of the savings generated by keeping people healthy are realized by Medicare, and not the insurer since everyone switches to Medicare at 65.

Not saying that makes it okay, that's just the reality if the current situation.

RisqueBarber posted:

This is probably true for any employer with over 150 employees. Self-funded plans typically cost less and allow more customization from the employer.

RisqueBarber posted:

There's a lot to digest here but first off, those 100 people should go to an urgent care not an ER.

tetrapyloctomy posted:

Lay people should never have to make a determination about whether something is or is not an emergency. Doctors gripe constantly about people with colds showing up who should have seen their PCPs, blah blah blah, but then the next post down is a de-identified ECG that cause d a cath lab activation and "This person came in for a sore throat."

RisqueBarber posted:

I was just stating the urgent care info as an education point. Patients should be charged based on what services they receive, not where they go for said services.

RisqueBarber posted:

I was just stating the urgent care info as an education point. Patients should be charged based on what services they receive, not where they go for said services.

kaynorr posted:

The costs for the services they receive should be paid for collectively by society, and those costs managed collectively as well.

Peven Stan posted:

Urgent Cares have a nasty habit of turning away medicaid patients, who then clog up the ER system with sniffles and troubles. I once went to a large teaching hospital’s ER after a head wound and the waiting room was full of people on a Saturday night. After I was admitted the guy on the gourney next to mine had been there for 48 hours without being seen for his complaint. They worked hard to prioritize the people with real problems like gunshot wounds first and the commercial insurance holders after that. Medicaid/uninsured got shafted.

Reik posted:

Saying how the system should be changed and saying what people should do today in their own best interest, because an Urgent Care visit will cost the policyholder significantly less as well, are two very different things.

Yes, it's insane that someone with a non-emergency issue gets tagged with the same ER facility charge as the person that has an emergency issue, but until we get that fixed people should go to an Urgent Care if one is nearby and open if they don't believe their life is in danger. If it turns out your issue is actually more serious, you'll probably actually see a doctor faster than if you went to the ER, and when the doctor realizes you are in danger, they can get you on an ambulance to the ER where you should receive appropriately prioritized treatment.

hobbesmaster posted:

Lay people are not qualified to make that determination and if they call someone educated like say a nurse's line for liability reasons they will almost always so to go to the ER.

Dead Reckoning posted:

The other solution here is to lower or eliminate liability for providers who, upon having vague, flu-like symptoms described to them, suggest that the patient wait and see their primary care provider. That means the "came in for a sore throat and wound up in the cath lab" patients are going to die, but I think it's fine to ask the question of whether it's worth it to try to get every patient who might have something wrong to be seen by the ER in order to chase those unlikely outcomes.