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Accretionist posted:Since UHC is off the table, are there any advantageous UHC-components we could push? A "network" is simply shorthand for "the providers we have contracts defining rates with". In-network pricing is "good" (better than out of network) because the insurer has a contract with the provider that says "no matter what you bill, you're getting paid this and you can't pass it on to the patient". The only way to have something analogous nationally would be for the government to mandate prices for all services. Which is a thing other countries do, Japan has had success with it, but it wouldn't fly with America's brokebrains free market religious fervor.
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Mar 8, 2017 22:16
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Hollismason posted:How is that a scam? Because ultimately they're paying themselves to justify their own insane prices. Patients can't even afford a 10% coinsurance on their drugs, so rather than give up that huge 90% they're getting from the insurance, they just write off that 10% that they're covering for the patient. They make more money overall that way rather than by just setting prices people can afford. It's a shell game.
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Mar 10, 2017 22:14
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evilweasel posted:I don't expect that to happen. The opiod crisis is a red-state issue more than a blue-state issue. Senators aren't going to go along with that. Walker has been openly espousing the idea that you only get drug treatment if you go into a job training program or work at the same time. Ideologues will still find a way to completely fail at saving their constituents from the white horse.
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Mar 16, 2017 22:21
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The Phlegmatist posted:I imagine they'd try to coup Ryan if anyone else wanted to be Speaker but that job is pretty much a political suicide booth right now. This is the only comfort I have about that gently caress being from my state. He is now doomed to go down in a Boehner-esque fireball. It's only a matter of when.
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Mar 22, 2017 18:28
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It's worth noting that a lot insurers will deny by default any claim with even a slight error on it and since they don't have to send a remittance until the claim is clean and truly paid or denied the doctor is basically the one stuck talking to random insurance staff until they figure out what was wrong with the claim.
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Apr 28, 2017 19:47
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Ogmius815 posted:But that's fair because the doctor's office usually submitted the claim, so the mistake is quite probably their fault. It's really dumb game playing poo poo a lot of the time though like "ssn address and birthday match but you spelled it Shawn instead of Sean in the name field so gently caress you waste lots of time fixing this." If they only denied for significant errors I'd agree with you.
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Apr 30, 2017 04:00
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Night10194 posted:They claimed my doctor only said I had arthritis so they just assumed it was rheumatoid and refused to give me the medication I'd been prescribed for my psioriatic arthritis. This went on for like 4 months until my doctor managed to hammer into the insurer what I had. Sounds like your insurer was pretending the last icd 10 deadline extension didn't happen. I work in the industry (on claims software. Yeah I feel bad every day). There's a laundry list of bs errors they can play games with if they feel like it.
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Apr 30, 2017 04:19
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Night10194 posted:That was like 2 years ago, and the nice part is as soon as I got the stuff it basically turned me from crippled to 'I can't do a pushup but I can do everything else' so that's been nice. Also, you gotta make a living. Yep, they were definitely ignoring the icd 10 extension.
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Apr 30, 2017 04:29
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hobbesmaster posted:You're saying that the insurer caused this mess because they truncated the input to just "arthritis"? No. There are diagnosis codes in claims. In icd 9 those codes are often less specific and the doctor probably sent the icd 9 code for a general diagnosis of arthritis. On icd 10 there's much more specific codes and the insurer likely denied it on specificity grounds despite, at the time, the deadline for provider icd 10 compliance being delayed. A lot of insurers have been playing that game since the first delay several years ago.
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Apr 30, 2017 20:05
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evilweasel posted:I think pregnancies are surprisingly expensive because humans are completely terrible at giving birth compared to, like, any other animal at all, and so even if nothing goes wrong you need a lot of people on call just in case something does go wrong, which also limits the number of people you can have that are potentially giving birth at any one time. there's some of that, but also hospitals insist on delivering from a laying position rather than squatting which is easier for the doctor but increases the complication rate for the mother. in addition, those "room fees" actually include all the nurses and other secondary staff involved because only doctors count as real humans with separate billable time (thus why you get both a CMS and UB claim for your delivery). Then you have the fact that every gauze they use is like a $20 charge (in case you were wondering where the title "charge nurse" comes from, they count all the chargeable supplies used and procedures done). The whole thing is pretty much structured to benefit the hospital to the detriment of the mother from the top down. How hosed it all is gets discussed pretty regularly in the feminism thread, but those discussions never happen in threads like this because MRAs instantly appear to accuse people of being hysterical and not really understanding what's involved.
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May 8, 2017 18:45
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Xae posted:That is the intent of HL7 which the ACA was pushing. Problem is congress was more interested in accusing vendors of lacking "interoperability" with little basis for the accusations than in actually pushing for hospitals and clinics (who are actually the ones who were refusing to hook up with each other for chart sharing) to set up connections. Literally every vendor worth buying has been able to send charts and data to anyone else since the early 2000s. Medical systems just view their patient data as proprietary and don't want to send it out of their network. It's hosed up.
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May 9, 2017 18:53
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Reik posted:http://www.factcheck.org/2017/03/medicaids-doctor-participation-rates/ in fact one of the most common ways to structure an insurance contract with a provider is to agree to pay x% of medicare rates. i have seen hundreds of fee schedules where everything across the board was "we pay 80% of medicare's rate".
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Jun 27, 2017 21:56
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Reik posted:I believe Medicare's rates are really high on labs? Were these fee schedules for lab/diagnostic services? they were for all sorts of things. ive worked in the managed care industry for over 5 years now producing health plan administration software so ive seen a hell of a lot of insurers' contract structures. i've genuinely seen multiple health plans that were 80% of medicare across the board. others only use it for subsets of their coverage. insurers like this approach because once they've negotiated that rate they don't really have to do much work as their rates will automatically adjust along with medicare, and doctors are typically more willing to trust a plan that's based on an org they trust, such as medicare, than a plan that was obviously assembled surgically by a room full of actuaries.
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Jun 27, 2017 22:10
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PerniciousKnid posted:Medicare rates aren't determined by actuaries? medicare, generally, is in the business of ensuring olds do not die rather than that the health plan makes maximum profit. i can't tell if you're being disingenuous or not.
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Jun 27, 2017 22:16
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evilweasel posted:I am uncomfortable with the idea that when the issue is not absolutely clear-cut, the doctor should substitute his view for the patient's view after giving them the requisite information, the doctor's recommendation, and the reasoning behind it. It's one thing to refuse to do quack surgery. It's another to refuse to do something where the risks weigh against the treatment but the patient may have reasons they prefer the treatment. It's more complex than this, though, medically speaking. There are cancers (and all sorts of other poo poo) that you could operate on but not operating has a better outcome. This is because any time you do a surgery or admit someone to a hospital, you are putting someone at risk of infections, sepsis, etc. Literally any surgery has a statistically significant likelihood of killing you and the choice of whether to do surgery is to balance the negative risks of surgery against the positive outcomes from treating the disease. Doing a mastectomy on a breast tumor that has a 99.9% chance of being harmless is factually less safe than just leaving it there. By doing that surgery the surgeon is actually increasing the patient's risk of death. Doctors give in to patient pressure to do surgeries anyway for all sorts of reasons but I think you're going astray in arguing that it's totally benign if they decide to operate vs not operate.
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Jun 28, 2017 21:08
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evilweasel posted:I don't view it as a benign choice. I am taking as a given that the surgery is a bad choice and saying that I am uncomfortable with the idea that as long as it's a bad choice that the patient's wishes shouldn't be honored. If you explain to the patient the negative risks and they have been provided with the full information, I think the patient should be able to make that decision rather than doctors refusing to participate when they disagree with the decision. There is a limit, of course: where there's no reasonable basis to do the surgery at all, it's a quack surgery, whatever. But I disagree with the person I originally responded to who was, in essence, arguing it's wrong for a doctor to agree to do that surgery. I believe the doctor's responsibility if he believes the surgery is a bad idea is to provide the information, provide the recommendation, and provide the basis for that recommendation, but then go through with it if that's the patient's decision. But that would be knowingly doing harm. If my tumor has a .01% chance of killing me but I have a 1% change of dying of a hospital-acquired infection post surgically, the doctor who performs that surgery is actively doing harm to me. That's unethical. That they do it anyway means that the customer is always right attitude has no place in health care.
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Jun 28, 2017 22:21
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VitalSigns posted:No it's not because we have evidence from other countries that have successfully implemented single payer that it achieves better medical outcomes at lower costs than a free market system, whereas we know austerity does not work because again we have evidence from here and from other countries that the cuts in public spending required to pay for the tax cuts shrink the economy and result in larger deficits in a spiral of self-defeat and economic destruction until the people finally put a stop to it by electing socialists in the good timeline or turn to fascists in the bad one. Evidence from other countries cuts both ways. Nationalized Healthcare systems have historically struggled to handle minority healthcare well. Taking longer to approve experimental treatments for diseases like aids, forcing trans people to wallow on years long wait lists and get through multiple layers of gatekeepers to get life saving hormone treatment, and leaving the very poor with no way to get second opinions or seek better care at facilities outside their primary care whole the rich can still buy their way into private hospital suites and better doctors. If you don't want uhc to be super regressive toward the most vulnerable it's not as easy as just "look at Europe". There's real problems there. For trans people specifically I can give you horror stories from nearly every uhc country but there's problems for every minority group.
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Sep 5, 2017 05:06
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Ohthehugemanatee posted:Did you just suggest that UHC systems are worse than the American system when it comes to treating poor folks and minorities because uh... America had the informed consent model for trans people and multiple clinics that provide hormone therapy for free no questions asked. Being trans is still awful here but you don't have to wait on a list for 3 years just to talk to the gatekeeper who refers you to the next gatekeeper who will question every aspect of your identity and then deny you care if you don't fit the traditional binary trans narrative to a T. Don't disingenuously act like it saying that it's worse abroad means it's perfect here. I just don't want to see access to care move backwards because informed consent is antithetical to the existing models of uhc we have. And to the guy calling me a 1 percenter, loving lol. I starred transitioning while I was still living on credit and selling poo poo in my house to pay bills (with insurance that covered nothing and required all sorts of arcane legal maneuvering to get anything covered at all). I didn't have it as bad as a trans person of color in like Alabama but I certainly didn't have it easy.
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Sep 5, 2017 06:55
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i used to work at epic. i would not want epic to make any decisions a doctor couldn't override. from my experience, it's a statistical anomaly that epics choices haven't killed more patients than they have. when their transgender care upgrades start to roll out i fully expect a bunch of transgender people to die or be killed after being outed to inappropriate care providers.
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Oct 5, 2017 05:42
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Lote posted:It's terrible right now regardless. The system doesn't recognize any trans patients so you get escalating warnings (with two !!s) if you try to order medications that may cause birth defects without a documented pregnancy test. I'm well aware. The solution they're going with (entirely at the fiat of Janet Campbell because she took gender studies on college for a humanities credit, seriously) is to mark every patient as "Transgender male/female to male" or "transgender female/male to female" and display that information to every single user of the system. And she doesn't think it's important to account for intersex people on this paradigm at all. The fact that leadership was listening to her and not their hundreds of trans employees with lived experience navigating the medical system is a big part of what drove me to quit.
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Oct 5, 2017 21:25
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The Phlegmatist posted:That's...actually important medical information though? only in certain situations. You don't need joe nurse tech who's giving you a flu shot to see your trans status. In many places in the country that puts you in immediate danger. Transgender people have to become very skilled at navigating the medical system and they should, when at all possible, be deferred to about whom to disclose to. My proposed solution, to only use the trans info to drive alerts when a doctor orders something contraindicated by transition treatments, was shot down by a room full of cis people as "overly paranoid". The Phlegmatist posted:Isn't it just in your EMR though? Maybe I'm misunderstanding. In epic's ecosystem everything in the hospital/clinic is done through the EMR. Front desk staff see your records, phone support sees your records, schedulers see your records, etc. There's abilities to filter down who can see what (for obvious security reasons), but Janet was extremely insistent that it was paranoid to think that we should not out transgender people to front desk staff and so on. Someone in an Alabama hospital is literally going to get killed by the changes Epic is making. edit: it sounds like you also work in medicine so if you want to discuss more feel free to PM me. we're probably getting too far away from the main topic at this point. The MUMPSorceress fucked around with this message at 20:20 on Oct 6, 2017 |
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Oct 6, 2017 20:07
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The Phlegmatist posted:Discharging patients into an SNF around here is basically a death sentence. They boomerang back and are readmitted inpatient on day 21 after the utilization manager kicks them out except now they have sepsis somehow. Fraud. I snf I used to do IT for (country villa in California) was fined for Medicare fraud when it was found that they were doping patients with phenobarbitol to make them look like they were declining so that they could bill Medicare for more severe cases. You'd go in with a replaced him and come out suffering alzheimers like symptoms and barely functional. Those places are not about treating people. They're Medicare funded meat lockers for the elderly.
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Feb 10, 2018 21:02
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Dead Reckoning posted:Diabetes? Latent brain trauma from being hit by a car? Hospital acquired infection? You idiot. You go to a snf because you are old and had surgery and keeping you in the hospital for your rehab is MRSA city. Most snf admissions are routine aftercare for routine operations.
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Feb 12, 2018 02:39
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icantfindaname posted:So here’s a tweet I read Weird to see my hometown paper being linked like that.
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Feb 22, 2018 21:19
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Wouldn't that just make the bill repealing the tax penalty unconstitutional? The aca as passed is constitutional. Another act modifying it creates an unconstitutional condition. Therefore striking down the penalty repeal is the simplest and most fair resolution.
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Mar 1, 2018 06:22
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Willa Rogers posted:The problem is that the mandate wasn't actually repealed; instead, the tax act reduced the penalty to $0. https://www.healthaffairs.org/do/10.1377/hblog20171220.323429/full/ [/quote] My primary point is that this makes the tax act unconstitutional, not the aca
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Mar 1, 2018 22:53
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Peven Stan posted:The jury is still out on whether or not high cholesterol causes heart disease Yeah. Every woman in my family has had horrifying cholesterol based on the standard ranges and they all live into their 100s anyway.
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Mar 7, 2018 04:28
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Reik posted:This seems like a pretty big deal, not sure if I missed it in here: I have uhc and they've been pretty good to me. They've covered several transition surgeries that my previous insurances considered "cosmetic". They even provide a specialist to help me navigate local surgeons and stuff.
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Mar 8, 2018 00:05
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Peven Stan posted:By 2030 we're going to have a single payer when all the pharmacy chains/insurance claims/PBMs/hospitals combine into a for profit kaiser style operation Kaiser only works because they literally write off internal claims. All their providers are salaried and there's no adversarial pricing involved in their services. An agglomeration of for profit entities would end up in a sears like holy war of intra org billing skirmishes and fall apart. Healthcare at that scale just doesn't happen affordably if you're seeking profit, at least not in the us.
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Mar 11, 2018 23:20
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Defenestration posted:My perscription expired with last month's bottle and the specialty pharmacy did not see fit to tell me this until I had ordered the next one. In order to get delivery before I run out of pills on Friday I had to: I go through this every month just to get ambien. It sucks. Condolences.
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Mar 15, 2018 06:58
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Spazzle posted:Kaiser for all Ugh, no thanks. Every trans person I've talked to on kaiser has had an awful time.
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Mar 29, 2018 22:31
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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. 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.
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May 2, 2018 21:56
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Seyser Koze posted:Yeah, Epic uses the same for the database end. Ya, as a former epic thrall, see my title text
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Aug 23, 2018 04:32
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Willa Rogers posted:When "thought leaders" in politics and media scream TAXES BAD and WE CAN'T DO IT on a 24/7 loop it's bound to affect polling. I mean, I'm pretty skeptical about Medicare for all for the specific reason that Medicare is so bad at paying for transgender care that a bunch of the big transgender care providers won't accept it and expect you to be able to pay cash or provide other coverage. That might not seem like a big deal except that it is the exact sort of thing that I expect the democrats to let fall through the cracks to get support to pass m4a. And my cynicism isn't unsupported; European socialized health care has been a nightmare for trans people with policy makers using gatekeeping and outdated psychology as a way to further marginalize and harass trans patients. On another front, it wasn't that long ago that dems happily dropped trans people from ENDA to try to get it passed. M4a will only be a success, in my eyes, if the people pushing it are simultaneously 100% committed to a detailed plan to make sure Medicare is fixed to meet the needs of minorities as well as it does the needs of old white folks. Socialized medicine can turn health care into a weapon governments can turn on minorities and given the state of our government I'd want ironclad protections for minorities built in so our next trump can't just take away access to health care for whichever minority is on the republican poo poo list that year.
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Jan 26, 2019 00:30
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