Healthcare Reform Megathread: Can I sell my organs to pay this hospital bill?

The Something Awful Forums > Discussion > Debate & Discussion > Healthcare Reform Megathread: Can I sell my organs to pay this hospital bill?

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tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Reik posted:

Turns out capping malpractice payments does reduce the doctors premiums but that doesn't get passed on to the patients:

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1635882

https://www.citizen.org/sites/default/files/a-failed-experiment-report.pdf

I'm not sure why people think tort reform would hugely decrease costs -- doctor's don't only practice defensive medicine because of the fear of getting sued, but also because we don't like missing diagnoses, period. More than that, though, it's not the economic fallout of malpractice that gets to us, it's the realities of the malpractice process itself. Think about it: Your expectation of care is never to miss anything and for there never to be a poor outcome even if that poor outcome could occur even in the absence of any error. On top of that, you can do everything perfectly and nail the diagnosis and treatment and be named in a lawsuit because the patient died (or suffered a complication) anyway from a problem that was severe when you first saw them, or because someone further down the line messed up. If you are named in that lawsuit, you have to report it forever even if you are dropped or the case is dismissed with prejudice because it was deemed frivolous. If your case is not settled before you are dropped, you get deposed, which is a miserable loving experience in itself because while it is billed as fact-finding, what their plaintiff's attorney really wants to do is make you accidentally slip up or contradict yourself on idiotic poo poo by asking questions repeatedly and trying to knock you off balance. If it actually goes to trial, the plaintiff will do everything in his or her power to make you seem like an idiot of a doctor, while calling expert witnesses who often have no real expertise in the area in question but who are willing to make wild and often incorrect claims about the standard of care in exchange for a few thousand bucks a pop. And this will take up years of your life.

That's why malpractice caps aren't going to make a difference in defensive medicine. Doctors don't want to go through it at all, not come out with their insurance company having to pay out less. And with malpractice awards being limited, insurers will be less likely to settle and will push more for going to trial since they have less to lose (while hoping that the plaintiffs will just give up because the cost of moving forward gets too high), dragging physicians along further into malpractice hell.

You want to fix malpractice? You tier it. You start off by admitting that there are lots of people out there who do deserve compensation but who aren't attractive clients to malpractice lawyers. The moment an error or poor outcome occurs you acknowledge it even if the victim doesn't even know something happened (which is the case for a lot of drug errors and the like). You offer people compensation up front for any additional hospital bills plus a reasonable payout for non-economic harms, in exchange for agreeing not to sue. You make this step as simple as possible so that people don't have to hire a lawyer in the first place for clear cases of harm. If someone decides to refuse and wishes to sue, then they may undergo factfinding through depositions and the like and present their case to a panel of experts along with whom they would like to name in the lawsuit, and the panel can move forward in entirety against parties now officially named, dismiss the case entirely , or remove people who did not contribute to the perceived poor outcome -- the last two groups need not report anything in the future regarding their involvement and can move on with their lives. From that point on, negotiations would continue as is current practice including trial if no settlement can be reached, with the exception that expert witnesses must maintain active credentialing and patient care in the field upon which they wish to testify.

This approach maximizes the number of people receiving compensation for error, minimizes the impact frivolous lawsuits have on physicians, but allows patients with extraordinary claims to make their case against the parties that caused harm. You'll find that doctors will feel more comfortable adhering to evidence-based practice instead of DOING loving EVERYTHING CAN'T MISS ANYTHING EVER, and it will decrease healthcare costs.

# ¿ Jun 29, 2017 20:01

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# ¿ May 3, 2024 12:26

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Piell posted:

Skinny repeal is dead

https://twitter.com/MarcGoldwein/status/890396857129725952

I'll believe it when I see its corpse. Only the grim brooding desert gods know what really took place, etc., etc.

# ¿ Jul 27, 2017 13:28

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Oxxidation posted:

That tweet was posted last night, it hasn't been confirmed, and if it was true then its likes/retweets would have skyrocketed by now. Probably wishful thinking.

Probably for the best, I'm getting a little weary of the Monkey's Paw outcomes of granted wishes anyway. Too many goddamned people who are dead-set on killing a bunch of folks so the rich can take in a few more bucks, and other funding can be siphoned into local pork and such. loving give it up, you monsters, and maybe work on improving life in the grand ol' US instead of trying to gently caress the poor (but only in other districts!).

# ¿ Jul 27, 2017 13:43

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

BarbarianElephant posted:

Imagine the dilemma of health insurance company bosses: They want the sweet, sweet tax cuts that the Republicans are offering. But they don't want the Republican's idiotic healthcare plans torpedoing their profits. What to do?

Nah, their investments have to be worth so much more than their taxable salaries. Plus, they have to keep those profits up so they can keep their sweet gigs!

I probably shouldn't look at how Vanguard's Healthcare mutual fund is doing until all of this shakes out.

# ¿ Jul 27, 2017 14:43

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

evilweasel posted:

Probably.

Talk about a great way to tank the support of the insurance industry, and subsequently every congressperson who has received donations from them. Actively wrecking the market also pretty much destroys any argument for Obamacare imploding -- it wasn't dying legislation that you compassionately euthanized, it was still plodding along and you shot its loving rider in the face.

# ¿ Jul 28, 2017 12:48

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

WampaLord posted:

If Dems take the House (highly likely), then it's loving dead no matter what happens with the Senate.

Wait, this is considered likely now? The Man In The High Chair dragging their approval down or not, don't they need to pick up two dozen seats or something, facing heavily gerrymandered districts and unprecedented voter suppression the oversight of which performed by increasingly-conservative judges?

# ¿ Jul 30, 2017 13:03

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

The reimbursement question is a huge one. We haven't even figured out if it's best to pay doctors for what they do, for what they diagnose, or for some nebulous quantification of "performance." How much should a PCP get reimbursed for spending fifteen minutes trying to maximize medical management of a known chronic condition in a patient with multiple social factors affecting compliance, versus an emergency physician doing an incision and drainage of an abscess in three minutes? Well, since the panel that determines physician reimbursement (by assigning "revenue value units," or RVUs, to every billable activity) is largely composed of physicians who perform procedures, primary care physicians get screwed. Tack in rules regarding medication reimbursement and physicians who administer certain medications can rake in obscene amounts of money. Throw in that you're going to get people arguing that US physicians make too much in the first place, countered by people who point out that medical education debt can be crushing, and you quickly find that the discussion is a quagmire.

So: Much more complicated than a copy-paste.

# ¿ Sep 16, 2017 02:02

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Spiritus Nox posted:

gently caress I can't do this again

JFC a thousand times this. I have gained approximately seventeen years of anger and cynicism in the not-quite-eight months since Trump took office.

# ¿ Sep 19, 2017 12:19

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

I'm sort of looking forward to a robot that can place IVs and such, this week I had to do a ton of EJs and US-guided lines on drug users who burned out all of their veins. I'm not particularly worried about my job; they haven't even gotten to the point where the automated reads of ECGs are reliable, let alone develop a system that could convert many of my patients' terrible histories and vague physical examinations into a useful management plan.

But not having to gently caress with needles near drug users? That would be great.

# ¿ Oct 1, 2017 10:52

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Crashrat posted:

I would love to read it even if it is several years out of date.

Me too. We switched to EPIC ASAP from MedHost a little over a year ago, and man, those first three weeks were the only time I seriously considered finding a new job. It's my understanding a lot of the broken-ness was because of the extent of the customization, but it was was still an awful experience. Now ... well, many charts I can complete as fast or faster than with MedHost, but I find them to be less readable. The inpatient notes are loving horrendous, though, with scads of extraneous information resulting in a ridiculously poor signal-to-noise ratio. I think the worst bit is that the structure of a top-notch system-wide charting system is there, but the presentation of information is ghastly.

Crashrat posted:

If shear ego can lead to mistakes - and it always will - then that ego has to be checked.

Luckily my ego is under compression.

# ¿ Oct 5, 2017 14:26

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

The Phlegmatist posted:

That's...actually important medical information though?

In some contexts. The registrars, technicians, cleaning staff, and so forth absolutely do not need to know this beyond how the patient self-identifies.

# ¿ Oct 6, 2017 12:16

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

The Phlegmatist posted:

Isn't it just in your EMR though? Maybe I'm misunderstanding.

Even the admin staff (aside from charge capture) couldn't pull your EMR at my hospital, much less the janitorial staff. We restricted access to EMRs as much as we could to prevent HIPAA violations.

It depends. In our build, there are several views, one of which is a rough map of the emergency department and another is a list. The janitors do have access to this, so they can see what rooms they need to clean. In an early build, the patient's name, age, complaint, and sex were visible on their screens and it is feasible that MTF/FTM could be displayed there if someone included those as choices. We incidentally just have "Male" and "Female," but for patients who are transgender it remains inconsistent whether the value refers to self-identification or birth sex, which also leads to confusion when there is someone in a room who appears female but is listed as male. Plus, actually changing this to the patient's self-identified gender **also** often causes issues, due both to software and also to ... less-than-progressive people who still believe that this is not something that can change. In any case, yes, there are ways that this kind of information sort of leaks out into other aspects of the software even if someone does not have access to a patient's full EMR.

# ¿ Oct 6, 2017 13:20

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

The Phlegmatist posted:

Epic ... is dumb.

That's the long and the short of it. I suspect a ton of it has to do with how much customization goes on at each site, leading to coding inconsistencies and errors. But a lot of it has to do more with the fact that Epic effectively is billing software first, and a medical communication tool second, which is precisely how hospital administration wants it to be.

# ¿ Oct 7, 2017 12:17

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Crashrat posted:

Everyone keeps bringing up customization in this.

First - if the hospital has all of this say over customization then how does Janet Campbell's edict have any power at all? If their clients say "this information should not be shown except for [specific user access levels]" that's not difficult to code - it's arguably a trivial thing to do for a company as packed full of programmers as Epic is supposed to be. It's definitely not hard for Epic to do, and it's an easy request a hospital can make.

Therefore

Is this just an issue where hospital administrators purchasing the software just don't care about this issue?

or

Is Epic making it seem like limiting information to certain user access levels is a really expensive thing to do and so hospitals don't do it.

There is so much poo poo going on with our build that I can imagine sometimes these issues manifest and sometimes they don't. Our registration system is decades old and only has M and F listed as options in the sex field, so I'm going to guess that partially drives what we see in Epic.

That said, once you receive your live build, there is a TON of poo poo that can't be fixed, because when you try it breaks three other functions. No kidding, when I order a genital swab for STDs, every single time I have to choose between genital and urine source even though the source is literally in the order name, because attempts to fix it screwed up other things.

There's so much that confuses me about our Epic ASAP implementation that I could write about it for days. Epic blames the hospital's choices, and the hospital implementation people blame poor feedback and overall responsiveness.

# ¿ Oct 7, 2017 14:05

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Lightning Knight posted:

It would be funnier if you made gun manufacturers pay for it, if we�re talking about bad healthcare policy rooted in spite.

100% the weapons and ammunition manufacturers -- as well as the individual people who sold him that much ammunition -- should be on the hook for the repercussions, in the same way that a bar owner who continues to serve a clearly intoxicated client and then allows him to drive home is liable. So naturally there is a law preventing it!

# ¿ Oct 29, 2017 20:14

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

SimonCat posted:

Should car manufacturers be on the hook for vehicular manslaughter?

Sure, when they design and market a car specifically designed to facilitate vehicular homicide as its primary function.

# ¿ Oct 30, 2017 18:12

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

BarbarianElephant posted:

And then say "no" to tests except those that are truly necessary because they can be $TEXAS.

Good luck parsing out what tests "are truly necessary." I routinely get into arguments with specialists about this. The patient has fever, vomiting, anorexia, and RLQ tenderness, with a 16mm appendix on CT, and some surgeons still want to know the white count. The patient is a shooter with a hot knee from which I pulled frank pus, and the orthopod still wants to know the ESR and CRP. And that's when the pathology is obvious -- if you come in and just look bad, are labs necessary or unnecessary? The answer is, "It depends on whether or not the results look bad, and whether you get better or worse with treatment."

Anyway, my point mainly is: gently caress this system, if I'm not sure whether a test ultimately will be helpful or not, the patient sure as hell shouldn't have to try to figure it out. Unfortunately, I'm also in a situation where patient follow up can be abysmal, and where missed or delayed diagnoses have a high litigation rate, so over-testing is the norm.

Honestly, I get way more patients demanding, "I want everything checked out," and getting angry when I refuse completely unnecessary or irrelevant tests. Every once in a while someone will voice concern about healthcare costs (almost always someone in his or her early twenties, just out of one of the local colleges, trying to find full-time work); they're a lot more receptive to skipping plain films for probable sprains, skipping labwork for probable vomiting and cramping that could be but probably isn't an early appy, etc. I generally "forget" to click some boxes on those charts so they get billed at a lower level, too.

# ¿ Jan 16, 2018 18:03

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

I'm looking at the in-process bills for my son's birth (via section after two days of attempted induction), and holy loving poo poo thank God our insurance is good.

# ¿ Jan 27, 2018 19:51

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

LeeMajors posted:

Our completely uncomplicated vaginal delivery of our daughter, with good insurance and deductible fully paid was still 6k out of pocket at the end of the day.

loving stunning how expensive healthcare is here.

The billed total for my wife and our son appears to be in the $60k range (induction, c-section, discharge three days after delivery), the bulk of it hers. Our cost was ... $300. Literally 0.5%.

# ¿ Jan 29, 2018 01:44

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Crashrat posted:

You just know Republicans are pissed that the PP-ACA included child birth, but knew there was no way they could spin the optics for "the plan covers everything but having children" to their base.

I'm sure they had extensive meetings and really, really tried regardless.

# ¿ Jan 29, 2018 13:01

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Total billed for admission for induction on 12/25, leading to c-section on 12/27, and discharge on 12/30 was approximately $60,000. Our out-of-pocket cost was $300.

# ¿ Feb 8, 2018 23:14

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Rhesus Pieces posted:

I guess in the meantime we'll just have to put up with poo poo like this:

https://twitter.com/npr/status/964469156472131584

From listening to it this morning, it sounded like the physician ordered a super-comprehensive UDS instead of the opiates/benzos/cocaine/marijuana/PCP one that I order every freaking day. Since the doc wouldn't be interviewed, I suspect he ordered the wrong thing and the patient got stuck with the bill.

# ¿ Feb 16, 2018 16:55

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

hobbesmaster posted:

You can see the bill in the link, it has to be fraud.

Jesus Christ, $425 for the pH, which was probably literally off of a dipstick.

# ¿ Feb 16, 2018 17:30

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

I'm going to go out on a limb and say that the insurance company would save a lot of loving money if it just approved the exception, since the alternative is "bullshit refill costs and frequency resulting in huge odds of decreased compliance leading to DVT/PE requiring hospitalization" (making an assumption about your diagnosis here). Seriously, it's loving ridiculous to burden you with that cost in both money and time, and I'm sorry you have to go through it.

# ¿ Mar 16, 2018 15:58

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Timby posted:

Correct assumption. Over a three or four-month period in 2015, I got sicker, and sicker, and sicker, eventually losing the ability to walk. Couldn't stand for more than a second. Etc. My dumbass doctor kept on thinking it was fibro, or something autoimmune or rheumatoid (because what otherwise healthy 31-year-old gets blood clots?). Eventually he sent me to the ER after a chest X-ray showed something in my lungs that he thought might be pneumonia. After being rushed into a trauma bay and then to a CT, I had a half-dozen small PEs and a whole bunch of clots in both legs, and one in my left arm. They told me I probably would have died in another day or two.

To be fair to your doctor, that's a super-weird presentation for a clotting disorder, and an autoimmune or rheumatoid issue makes sense -- especially since your inflammatory markers must have been super-high! I'm trying to think what I'd do in terms of a workup, but my field approaches things differently than, well, just everyone else and it would heavily depend on what your chief complaint happened to be the day you came into the ED.

(Somewhere, a radiologist is reading this and saying, "Pffft, you're an emergency doc, which means you're going to end up doing a PE study for some stupid reason or another. and figure it out through sheer luck.")

Really, though, it's hard to imagine you getting a pulmonary infarct (which is what I presume he saw on the plain film, a wedge-shaped section of lung that's all inflamed because it lost blood flow due to a clot, and looks like a pneumonia) without ever having any clinical signs at all of a large-enough clot to cause it. With continuous symptoms from smaller clots, though, I could see someone missing the significance of, say, new left calf cramping or pain along the deep venous course.

I'm sorry if this sounds like I'm minimizing the frustration you must have felt for all that time that your doctor missed the diagnosis, and the anger you must have felt when you discovered that the delayed diagnosis could have killed you. I just try to keep things like this in mind when I see people whose presentations just don't seem to make sense, or whose subjective symptoms are out of proportion to what I'm seeing on examination. It's really, really easy to be that rear end in a top hat who kicks you out because complaints are vague or chronic or seemingly nonsensical "because there are people with emergencies who need the bed" -- especially when we ideally see people once and they never need to go to an ED again! -- and sometimes I need a personal example to smack some jadedness out of me.

A little back on track: Have you tried http://www.sanofipatientconnection.com/ ? I just wonder if they could help with some type of copay reimbursement or something.

# ¿ Mar 16, 2018 17:03

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Republicans posted:

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

Sort of. Deals like these involve the drug companies scamming the insurance companies, who in turn scam the consumers. Who knows what the billed costs and actual payouts would be under, say, Medicare For Everyone. Now, if there were a way to move to non-profit pharmaceutical firms ...

# ¿ Apr 28, 2018 11:07

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

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.

Epic has some great features, but as I suppose should be expected it is a system designed first to maximize billing, and second (or third, or fourth) to provide an easily-readable medical narrative. It's a shame, because a clean interface that approximated the presentation of a typical inpatient chart would be amaaazing when coupled with the capacity to see notes fro other hospital systems in Care Everywhere. The latter has saved me enormous amount of energy with malingerers and doc-shoppers, and in and of itself is probably worth the three weeks of rollout that made me want to quit my job and do non-clinical work somewhere instead.

Avalanche posted:

EClinicalWorks can suck my cock.

That's loving crazy. I'll have to keep this post in mind; sooner or later someone on the EM Docs Facebook group will probably have to deal with them and knowing that there's already been a huge settlement on the issue will help them out.

# ¿ May 6, 2018 13:45

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

RisqueBarber posted:

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

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."

# ¿ May 7, 2018 18:35

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

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.

Yes.

kaynorr posted:

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

gently caress yes.

# ¿ May 7, 2018 20:03

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Reik posted:

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

A lot of these places are cheaper because they staff with nurse practitioners who, while very good at many things, have nowhere near the level of training of a board-certified emergency physician. They're strongly pushing for total autonomy in many states, though, which eventually will backfire on them when they become solely liable for the same sorts of damages that previously were tacked onto the supervising physician's malpractice.

Peven Stan posted:

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.

Doctors in the emergency department give zero shits about your insurance status. Specialists do wallet biopsies, but we don't have time for that poo poo. (Furthermore, in many academic departments with a high level of uninsured patents, the uninsured are more likely to receive immediate specialist consultation and inpatient management, because the specialist will not get reimbursed for an uninsured office visit. So they instead take care of the patient in the ED or admit and get case management to work on emergency coverage.)

Dead Reckoning posted:

I'm talking about taking steps to limit defensive medicine.

It would appear that states that enact tort reform do not end up seeing a decrease in defensive medicine. My hypothesis is that it's not that amount of the payout that makes doctors fear malpractice lawsuits, it's the process. I think that we could see results by reforming the malpractice process in a fashion that doesn't mean that simply being named in a lawsuit is a fantastically stressful, months-long event. If done properly, I think that we could increase the number of people who receive payment for legitimate malpractice claims, decrease the number of high-ticket Hail Mary lawsuits, and alleviate the litigation anxiety (as opposed to "payout anxiety" that most tort reform targets) that lead more directly to defensive medicine.

Also, if we loving paid primary care physicians enough so there were more of them and I could guarantee rapid follow up, I'd discharge a lot more people without comprehensive workups. Same goes with ensuring more immediate access to specialists. You know what would help? Socialized loving medicine.

# ¿ May 8, 2018 12:47

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Azhais posted:

My last ER visit cost me around 3k because anthem is so hostile to ERs. Basically if you're not admitted to the hospital you can go gently caress yourself

Depending on the company staffing the emergency department, there may be a price-gouging component as well.

# ¿ May 19, 2018 18:01

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

VitalSigns posted:

What's the margin on uninsured people showing up in the ER and never paying their bills

When I was in residency my emergency department was reimbursed 14% of what was billed. Since then EMRs have increased both billing and reimbursement, but I don't know whether the ratio of collections to billed amounts has changed. In any case, I suspect that applying even Medicare's historically-terrible reimbursement schedule across all patients would result in a net gain over the current system. (That totally would not be the case for nearby community hospitals with much better payer mixes.) Many hospitals still would require additional subsidies to keep the doors open, however, and unless the Medicare fee schedule was dramatically altered many primary case physicians might not remain solvent.

# ¿ Jun 12, 2018 13:03

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

It is possible that you misunderstand the dangers of applying population statistics to individuals. It is also possible that this is not your largest issue to tackle.

# ¿ Aug 4, 2018 19:15

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

litany of gulps posted:

Or perhaps a focus on making home testing for bacterial illness more affordable? Why do I need to pay 200 bucks for some goober to swab my mouth and tell me there's nothing they can do for me? Why can't I do that myself? This situation is what drives people to take antibiotics without seeing a professional.

People are still struggling with "you don't need antibiotics, it's a viral infection." I'm not sure throwing in "you need to learn about Bayesian analysis as well as the difference between 'colonization' and 'infection'" is gong to go over well.

# ¿ Sep 2, 2018 02:36

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

qkkl posted:

There should be a "surgery school" option where new med school graduates can pay big money to skip residency and get heavily trained by practicing doctors, including supervised training on fake models and real patients. This way they can become a practicing physician faster than if they went into residency, without compromising on the quality of their work.

What exactly do you think happens in residency training that should be skipped?

# ¿ Nov 11, 2018 02:17

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

First off, Neurosurgery is its own residency, as is Orthopedics. Same goes for Ob/gyn, Urology, Ophthalmology, and Otolaryngology. For those other subspecialties such as cardiothoracic, GI, the process of a general surgery residency provides the fundamental physical and cognitive skills needed in order to be a competent surgeon in those fields; if you tried to skip straight to subspecialty training you'd end up putting people through the same process but with additional, non-centralized administrative and oversight overhead. You'd also lose the utility of the general surgery residency with regard to determine who actually LIKES and is competent at the subspecialty.

There are plenty of issues with medical education, but if it even is one in the first place, the current fellowship model is way down on the list.

# ¿ Nov 11, 2018 09:20

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

Cheesus posted:

gently caress this country's healthcare system anyway.

Pretty much this. Even if there is a valid reason for such late billing, it's probably because of the labyrinthine nature of working through so many disparate systems to bill and, as such, is due to the fuckery of our healthcare system.

# ¿ Nov 18, 2018 16:45

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

hobbesmaster posted:

Zuckerberg San Francisco General Hospital

Use the full name so we can fully embrace the cyberpunk dystopia

I gotta say, I for one missed the Kickstarter for CyberZuck 2.0.2.0.

# ¿ Jan 29, 2019 12:54

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

surf rock posted:

She shouldn't still be listed, should she? And is he paying 2x what he should be paying for health insurance because the plan has two people?

In my experience, family coverage has been more than twice individual coverage. He needs to tell his employer to remove her from the policy, and if he did tell them that hopefully he has it in writing.

# ¿ Apr 10, 2019 13:48

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# ¿ May 3, 2024 12:26

tetrapyloctomy: Feb 18, 2003; Okay -- you talk WAY too fast.; Nap Ghost

LeeMajors posted:

I know you know this but that poo poo drives me inlovingsane.

Any loving idiot who has ever said this either
A) has never had to use their insurance or
B) has a vested interest in the status quo.

B is usually affluent enough for our hellish healthcare system to not affect them.

I do love our insurance -- my wife's induction and subsequent section cost us $300 including the entire hospitalization and immediate post-partum follow up -- but the fact of the matter is that the only reason one can love their insurance is because the thought of going without it is terrifying. I shouldn't have to love our healthcare coverage. It should just be a thing that is there that I appreciate when I need it, but which everyone else has as well.

# ¿ Nov 4, 2019 12:42

The Something Awful Forums > Discussion > Debate & Discussion > Healthcare Reform Megathread: Can I sell my organs to pay this hospital bill?

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