Some doctors are morons.

Norman said:
Gary,

If I ever need brain surgery I want Ben Carson. :yes:
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I think he retired from neurosurgery a year ago.

I had the good fortune of watching a baseball game with him many years ago. A very interesting man.
 
I don't understand why more of the posters here are not doctors. I mean, it's clear that you can make megabucks as a moron who doesn't know what he's doing and screws up all the time. So why isn't everyone practicing medicine?

:dunno: :rolleyes2:
 
Lindberg said:
I don't understand why more of the posters here are not doctors. I mean, it's clear that you can make megabucks as a moron who doesn't know what he's doing and screws up all the time. So why isn't everyone practicing medicine?

:dunno: :rolleyes2:
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I look stuff up on the internet, and I stayed at a Holiday Express.:)
 
Gary F said:
Much of the problem of perceived incompetence is the result of the dysfunctional structure of the medical system. We often rely on generalists when specialists can make better decisions. Providers are often forced to perform outside of their area of competence. Does anyone here really believe that the field of medicine attracts so many total dumbasses that manage to complete rigorous training?
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bartmc said:
All the guys at Mississippi state who went to med school were the ones who couldn't get into vet school. :stirpot:
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I get it, a joke, right? There may be an occasional Vet school applicant who gets accepted to medical school but how does that have anything to do with my prior post? The advantages of being a Vet is that there is much less government interference (so far), lower malpractice premiums and their patients are probably far less obnoxious than many humans we must treat.
 
weilke said:
You accuse me of being a liar ?
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As Chrissy pointed out in a spin zone thread, just because he told someone to stop lying, doesn't't mean, in his feverish mind, that he called him a liar.

Something to keep in mine before you repeat your challenge...
 
Gary F said:
I get it, a joke, right? There may be an occasional Vet school applicant who gets accepted to medical school but how does that have anything to do with my prior post? The advantages of being a Vet is that there is much less government interference (so far), lower malpractice premiums and their patients are probably far less obnoxious than many humans we must treat.
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Some might say the advantage of being an MD is you don't have to stick your arm up a cow's ass at 3am.

Seriously though, I have been in the horse business for two decades. God bless the large animal veterinarians, but I have seen it transpire before my eyes that many are now treating based on what insurance will pay for. The first question is "this horse insured?". Not all, but some.

The only difference is MD's have such a large head start. Other peoples money is easy to spend when you're both buyer and seller.
 
Chip Sylverne said:
Some might say the advantage of being an MD is you don't have to stick your arm up a cow's ass at 3am.
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Most medical activities are more fun when you don't have to get out of bed in the middle of the night to do them.
Chip Sylverne said:
Seriously though, I have been in the horse business for two decades. God bless the large animal veterinarians, but I have seen it transpire before my eyes that many are now treating based on what insurance will pay for. The first question is "this horse insured?". Not all, but some.

The only difference is MD's have such a large head start. Other peoples money is easy to spend when you're both buyer and seller.
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I think you are on to something. Why don't you elaborate? Financial bias is a huge problem in medical decision making and reducing it could result in a major improvement in cost and quality.
 
Gary F said:
I think you are on to something. Why don't you elaborate? Financial bias is a huge problem in medical decision making and reducing it could result in a major improvement in cost and quality.
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We've had this discussion previously, I think.

Physicians are in the position of being both the buyer of services and equipment on behalf of the patient, IOW, "you need this pill, procedure, equipment or you going to die. Let's schedule you in. I'm the doc, I know best". No, frightened, insured patient is going to argue, and only recently with the advent of higher deductibles are patients even going to ask how much it's going to cost. More times than not, that info is not available. There's little transparency. It's also the rare patient that's going to say, " wait a sec. I want to research the procedure, the outcome and the risks involved. Let me get back to you."

The doc is in the driver's seat. All the power. We know what that does.

So the provider both makes the buying decision, sells the service and controls the price in an opaque environment. The incentives are perverse to establishing a real market. Of course, insurance companies and state authorities are establishing pricing power, but the element of buyer and seller being one remains.
 
Chip Sylverne said:
People conflate non-profit with altruistic. That ain't necessarily so.
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I'm on the board of directors for a non-profit. Not a hospital, and not a paid position either. Non-profit does not mean, doesn't make enough money to pay the employees. Our non-profit makes good money, and our employees are one of our most important resources. They are compensated well. I don't know where people come up with the belief that all non-profits are just scraping by. And it isn't any secret either. Non-profits are regulated by tax law and that is a matter of accounting. Our non-profit is very careful to stay within those parameters. There is a ton of oversight. But don't ever think that non-profits are not doing well. Our non-profit has been growing by leaps and bounds.
 
Chip Sylverne said:
We've had this discussion previously, I think.

Physicians are in the position of being both the buyer of services and equipment on behalf of the patient, IOW, "you need this pill, procedure, equipment or you going to die. Let's schedule you in. I'm the doc, I know best". No, frightened, insured patient is going to argue, and only recently with the advent of higher deductibles are patients even going to ask how much it's going to cost. More times than not, that info is not available. There's little transparency. It's also the rare patient that's going to say, " wait a sec. I want to research the procedure, the outcome and the risks involved. Let me get back to you."

The doc is in the driver's seat. All the power. We know what that does.

So the provider both makes the buying decision, sells the service and controls the price in an opaque environment. The incentives are perverse to establishing a real market. Of course, insurance companies and state authorities are establishing pricing power, but the element of buyer and seller being one remains.
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I know all of that. What's your solution?
 
Gary F said:
I know all of that. What's your solution?
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I don't deal in spin zone material any more. The ACA, single-payer vs. other insurance models... It's just not productive discussion anymore. If you mean without regard to practical political matters, and I could wave a wand...

1. Reduce the cost of medical school. $300k+ is an obscene amount. You exclude many of the best and brightest out of the box, and limit the pool to those who can afford it, or those who are willing to burden themselves with crushing debt now for the promise of future earnings. For perspective, $4 billion spent on a midterm election is 13.5k full ride medical educations.

2. Eliminate pharma ads. I personally believe that alone is responsible for much of the negative change that occured in health care in the past couple of decades. Add hospital advertising in there too. Hospitals competing on the basis of amenities is farcical.

3. Institute the French medical data card. It makes a lot of sense to me that a person should be able to carry their cradle-to-grave medical history with them on a card mounted chip, able to present it to any doc at any time.

4. Compensate Docs for their time and knowledge, not necessarily for performing procedures. Find a way to collect data to determine which protocols, procedures and treatments deliver the best outcomes at the lowest cost, without engendering resentment from the medical community regarding the interference in their practice of medicine.

5. Get the amount spent on geriatrics in the last few months of life under control, either through hospice or home care. Parking old folks in hospital to die, oftentimes at odds with their final wishes, is a huge waste of resources.

6. Change US food culture away from prepared foods and junk, eliminating much of the cause of diabetes, heart disease and such. Wellness is a "thing". Unfortunately it generally takes a medical emergency to incent a healthy lifestyle change.
 
Florida Cracker said:
As Chrissy pointed out in a spin zone thread, just because he told someone to stop lying, doesn't't mean, in his feverish mind, that he called him a liar.

Something to keep in mine before you repeat your challenge...
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You want to talk about me and call me names, take it to SZ, Florida, where it's not at all appropriate, but tolerated.
 
Chip Sylverne said:
I don't deal in spin zone material any more. The ACA, single-payer vs. other insurance models... It's just not productive discussion anymore. If you mean without regard to practical political matters, and I could wave a wand...
Chip Sylverne said:
1. Reduce the cost of medical school. $300k+ is an obscene amount. You exclude many of the best and brightest out of the box, and limit the pool to those who can afford it, or those who are willing to burden themselves with crushing debt now for the promise of future earnings. For perspective, $4 billion spent on a midterm election is 13.5k full ride medical educations.
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The high cost of medical education will be paid by somebody and you are not addressing the cost, just slightly modifying how it gets distributed. I had a free ride for medical school paid for by the taxpayers (Army HPSP scholarship).
Chip Sylverne said:
2. Eliminate pharma ads. I personally believe that alone is responsible for much of the negative change that occured in health care in the past couple of decades. Add hospital advertising in there too. Hospitals competing on the basis of amenities is farcical.
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I don't like them either but there are limits how the government can limit speech. I prescribe 80-90% generic meds so these commercials have no effect on my practice. It's rare for anybody to ask me to prescribe anything advertised. I have been asked to write for vitamin V (Viagra) but I think that class of medications does not need to be advertised anymore. Advertising does not contribute substantially to the total cost of healthcare.
Chip Sylverne said:
3. Institute the French medical data card. It makes a lot of sense to me that a person should be able to carry their cradle-to-grave medical history with them on a card mounted chip, able to present it to any doc at any time.
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Not a bad idea and we also need to work on a standardized format for medical records. This could actually improve the cost and quality of medical services by reducing the time providers spend hunting down information.
Chip Sylverne said:
4. Compensate Docs for their time and knowledge, not necessarily for performing procedures. Find a way to collect data to determine which protocols, procedures and treatments deliver the best outcomes at the lowest cost, without engendering resentment from the medical community regarding the interference in their practice of medicine.
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I also agree with you here. Fee for service is ridiculous. Compensation should be based results.
Chip Sylverne said:
5. Get the amount spent on geriatrics in the last few months of life under control, either through hospice or home care. Parking old folks in hospital to die, oftentimes at odds with their final wishes, is a huge waste of resources.
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I agree on this one. Providers may profit from providing futile medical care as much as effective medical care. This may be politically difficult to implement (death panel scare mongering).
Chip Sylverne said:
6. Change US food culture away from prepared foods and junk, eliminating much of the cause of diabetes, heart disease and such. Wellness is a "thing". Unfortunately it generally takes a medical emergency to incent a healthy lifestyle change.
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You and Michelle think a lot alike. Unfortunately this wont go over any better than those crummy school lunches. I have a problem with the government cramming lifestyle edicts down my throat. Apparently, so do a lot of kids:

It was just a week ago when an Oklahoma teen’s picture of her school lunch went viral on social media.
It turns out that student is not alone in grumbling about school lunches, an investigation by the Washington Bureau discovered.
Since new federal nutrition standards began rolling out in 2012, fewer students are buying school lunches, even though enrollment is going up.
The Cox Washington Bureau reviewed U.S. Department of Agriculture documents and found thousands fewer students bought meals when stricter standards kicked in.
http://www.wsbtv.com/weblogs/news-c...eports-show-less-students-buying-school-lunc/
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Chip Sylverne said:
2. Eliminate pharma ads. I personally believe that alone is responsible for much of the negative change that occured in health care in the past couple of decades. Add hospital advertising in there too. Hospitals competing on the basis of amenities is farcical.
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I believe there is a difference between drug company ads and hospital advertising. While the drug ads may motivate someone to seek a brand name drug rather than a generic and drive up cost, nobody goes to the ER because they saw and Ad, they go because they are sick. What is kind of silly are the billboards that advertise ER wait times, but then why shouldn't there be customer pressure to keep them down ?

3. Institute the French medical data card. It makes a lot of sense to me that a person should be able to carry their cradle-to-grave medical history with them on a card mounted chip, able to present it to any doc at any time.
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That could have been mandated with the stroke of a pen, but it wasn't.

It is comical, we use the same medical records system as our main competitor, sometime patients go back and forth between us. The systems are based on a SQL database. You would think I can just have them send me a patients chart on a CD and backload their visits, but no, unless we both have exactly the same version of the system, we would have to match it over field by field to load a single record. So, printed paper it is.....

I love the idea of a data card. Mandate a standard file format, encrypt it and drop it on the card. But you know that the black helicopter faction would blow a gasket if the goverment mandates a standard record.

Medical imaging has actually gone to a uniform standard. It was driven by industry and at times a painful process, but now 20 years later it works pretty well. There are vendor neutral archives and we can load studies from most other systems through use of a 'promiscuous workstation'. The only obstacles to interchange imaging data are usually rooted in local hospital politics. Thankfully, where I work, the hospitals have been smart enough to move past that and we are hooked up with everyone, even our main competitor.

4. Compensate Docs for their time and knowledge, not necessarily for performing procedures.
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After I account for the post-op care rolled into the procedures, the per-hour reimbursements are actually not that attractive for the procedural side of the practice. It is a wash whether a provider is in the OR or sees new consults back to back.

Find a way to collect data to determine which protocols, procedures and treatments deliver the best outcomes at the lowest cost, without engendering resentment from the medical community regarding the interference in their practice of medicine.
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Oh, data collection. We already collect data left and right, but they disappear into a dark hole somewhere at CMS. There is a downside to the data collection obsession, and that is the increase in administrative work it brings with it and the bad changes in medical practice it creates. For example, CMS has decided a couple of years to record data on how many patients with pneumonia get antibiotics within 3 hrs of getting to the hospital. The financial penalty for having patients above the 'benchmark' is stiff and can be in the millions for a larger hospital. The result is that you can't make it out of a hospital ER with a fever these days without getting carpet-bombed with antibiotics. Buerocrats suck at practicing medicine.

5. Get the amount spent on geriatrics in the last few months of life under control, either through hospice or home care. Parking old folks in hospital to die, oftentimes at odds with their final wishes, is a huge waste of resources.
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Actually, we need to spend MORE money on geriatrics. The best money we can spend in medicine at this point is to train more specialists in geriatrics. Once patients are under the care of a geriatrician, a lot of the craziness in the last 6 months of life goes away and the odds of the patients own wishes being respected go up.

The biggest problem is to figure out when the last 6 months begin. Insurance companies are pretty good predicting this, but I dont think we would be happy if they started to tell us.

6. Change US food culture away from prepared foods and junk, eliminating much of the cause of diabetes, heart disease and such. Wellness is a "thing". Unfortunately it generally takes a medical emergency to incent a healthy lifestyle change.
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Good Luck !!
 
Chip Sylverne said:
4. Compensate Docs for their time and knowledge, not necessarily for performing procedures. Find a way to collect data to determine which protocols, procedures and treatments deliver the best outcomes at the lowest cost, without engendering resentment from the medical community regarding the interference in their practice of medicine.
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weilke said:
Oh, data collection. We already collect data left and right, but they disappear into a dark hole somewhere at CMS. There is a downside to the data collection obsession, and that is the increase in administrative work it brings with it and the bad changes in medical practice it creates. For example, CMS has decided a couple of years to record data on how many patients with pneumonia get antibiotics within 3 hrs of getting to the hospital. The financial penalty for having patients above the 'benchmark' is stiff and can be in the millions for a larger hospital. The result is that you can't make it out of a hospital ER with a fever these days without getting carpet-bombed with antibiotics. Bureaucrats suck at practicing medicine.
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Weilke has just scratched the surface on this one. The problem is that there is not one best diagnostic or treatment protocol as patients are complicated individuals. CMS is shoving "guidelines" down our throats under the threat of criminal prosecution. Cookbook medicine has significant limitations but it make bureaucrats happy and private contractor auditors rich.

Chip Sylverne said:
5. Get the amount spent on geriatrics in the last few months of life under control, either through hospice or home care. Parking old folks in hospital to die, oftentimes at odds with their final wishes, is a huge waste of resources.
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weilke said:
Actually, we need to spend MORE money on geriatrics. The best money we can spend in medicine at this point is to train more specialists in geriatrics. Once patients are under the care of a geriatrician, a lot of the craziness in the last 6 months of life goes away and the odds of the patients own wishes being respected go up.
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We should also increase the amount and quality of geriatric training in medical school and residency. A wise geriatrician taught me that one of his most important jobs was to stand between the patient and the specialists.
 
Gary F said:
We should also increase the amount and quality of geriatric training in medical school and residency. A wise geriatrician taught me that one of his most important jobs was to stand between the patient and the specialists.
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And often between the patient and their crazy family. If you are old and sick, the worst thing that can happen to you is a hospital visit from the out of state kid that only comes around every 6 months but insists that 'everything has to be done'.
 
Maxmosbey said:
I'm on the board of directors for a non-profit. Not a hospital, and not a paid position either. Non-profit does not mean, doesn't make enough money to pay the employees. Our non-profit makes good money, and our employees are one of our most important resources. They are compensated well. I don't know where people come up with the belief that all non-profits are just scraping by. And it isn't any secret either. Non-profits are regulated by tax law and that is a matter of accounting. Our non-profit is very careful to stay within those parameters. There is a ton of oversight. But don't ever think that non-profits are not doing well. Our non-profit has been growing by leaps and bounds.
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No one in the discussion has said anything of the sort. You're assuming things.

FedGov is the largest non-profit in the U.S.

It's now the very epitome of "evil corporation" -- as its employees like to claim the folks working for smaller lesser ones are. None of us are actually voting for any of the spending at this point.

So all of us know all about non-profits. We have the worst example of an out of control and mismanaged one, setting our Country's laws, every day.
 
cg2112 said:
You want to talk about me and call me names, take it to SZ, Florida, where it's not at all appropriate, but tolerated.
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What's the matter, chrissy?

Can't deal with the facts so you HAVE to change the topic? Again?
 
Florida Cracker said:
What's the matter, chrissy?

Can't deal with the facts so you HAVE to change the topic? Again?
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What are you talking about? And why are you bringing me up in threads that I'm not participating in? Why are you attacking me, without provocation, outside of SZ? Are you a child?
 
cg2112 said:
What are you talking about? And why are you bringing me up in threads that I'm not participating in? Why are you attacking me, without provocation, outside of SZ? Are you a child?
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Evidently a troll.
 
cg2112 said:
What are you talking about? And why are you bringing me up in threads that I'm not participating in? Why are you attacking me, without provocation, outside of SZ? Are you a child?
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Try to remain alert, and avoid the whining, dishonest claims about not having any idea what is going on, and trying to make everything about you, and see if it helps, chrissy.
 
Chip Sylverne said:
I don't deal in spin zone material any more. The ACA, single-payer vs. other insurance models... It's just not productive discussion anymore. If you mean without regard to practical political matters, and I could wave a wand...

1. Reduce the cost of medical school. $300k+ is an obscene amount. You exclude many of the best and brightest out of the box, and limit the pool to those who can afford it, or those who are willing to burden themselves with crushing debt now for the promise of future earnings. For perspective, $4 billion spent on a midterm election is 13.5k full ride medical educations.

2. Eliminate pharma ads. I personally believe that alone is responsible for much of the negative change that occured in health care in the past couple of decades. Add hospital advertising in there too. Hospitals competing on the basis of amenities is farcical.

3. Institute the French medical data card. It makes a lot of sense to me that a person should be able to carry their cradle-to-grave medical history with them on a card mounted chip, able to present it to any doc at any time.

4. Compensate Docs for their time and knowledge, not necessarily for performing procedures. Find a way to collect data to determine which protocols, procedures and treatments deliver the best outcomes at the lowest cost, without engendering resentment from the medical community regarding the interference in their practice of medicine.

5. Get the amount spent on geriatrics in the last few months of life under control, either through hospice or home care. Parking old folks in hospital to die, oftentimes at odds with their final wishes, is a huge waste of resources.

6. Change US food culture away from prepared foods and junk, eliminating much of the cause of diabetes, heart disease and such. Wellness is a "thing". Unfortunately it generally takes a medical emergency to incent a healthy lifestyle change.
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Well done. I will add a few postulates if I may.

2. While eliminating pharma ads sounds enticing, and it surely has worked for the cigarette business, I'm not enough of a progressive that I can wave the wand and restrict one segment of the market such that the govt controls media this much. While I detest the pharma method, I detest media control by govt more. Maybe we can just put a 300% tax on all Viagra and Cialis ads, hehe!

6. As with 2, incentivizing healthy behavior is something that is going on right now with Michele Obama. Frankly, and with no design on the politics of it, she should get the **** out of this arena, or if there is going to be an incentive, it can't have laws, rules, and regulations behind it. That's no kind of incenting behavior, it's just progressivism with a stick. See also - Bloomberg and giant sodas.

7. I will add my own items; Cost transparency. Like few other things ever paid for, the medical insurance payment system has so muddied the waters of costs that no one can get a straight answer anymore. Frex, I was going to have my kids wisdom teeth removed. I started talking to the oral surgeon and we chatted about costs for maybe 15 seconds. I just could never nail down what this was going to cost. I have dental insurance, and I wanted the cost to put on my own insurance forms. The office wanted to submit it, but they would only do that with my SSN. I said no. After 5 phone calls, and maybe 2 hours with them, I got at least 8 different prices for the basic removal of the teeth with no complications. We need to know what it costs when the doctor steps into the room, and looks at the chart, and walks out again, and we need to know in advance. Unless this is a life or death emergency, I would and have prohibited any random 'health professional' from seeing me. Not only will transparency show where there are savings, it will also foster competition.

8. Either single billing, or independent billing but not both/all. From one emergency room visit, I've gotten bills from at least 6 different places. including one collections agent after 15 months! And that from a guy who wasn't even practicing at the hospital when I was admitted. Nice try...

9. Insurance offerings. We need a product that will offer catastrophic coverage, and have a high/medium deductible at low cost. I want to be able to pay cash for setting a simple broken leg(not compound femur, with pins, and vascular damage of course). I want to be able to pay cash for an office visit with a chest pic. Then, when my headache turns into a tumor in the stem of my head, I have insurance that I can rely on to cover the big, ugly stuff.
 
docmirror said:
Well done. I will add a few postulates if I may.

2. While eliminating pharma ads sounds enticing, and it surely has worked for the cigarette business, I'm not enough of a progressive that I can wave the wand and restrict one segment of the market such that the govt controls media this much. While I detest the pharma method, I detest media control by govt more. Maybe we can just put a 300% tax on all Viagra and Cialis ads, hehe!

6. As with 2, incentivizing healthy behavior is something that is going on right now with Michele Obama. Frankly, and with no design on the politics of it, she should get the **** out of this arena, or if there is going to be an incentive, it can't have laws, rules, and regulations behind it. That's no kind of incenting behavior, it's just progressivism with a stick. See also - Bloomberg and giant sodas.

7. I will add my own items; Cost transparency. Like few other things ever paid for, the medical insurance payment system has so muddied the waters of costs that no one can get a straight answer anymore. Frex, I was going to have my kids wisdom teeth removed. I started talking to the oral surgeon and we chatted about costs for maybe 15 seconds. I just could never nail down what this was going to cost. I have dental insurance, and I wanted the cost to put on my own insurance forms. The office wanted to submit it, but they would only do that with my SSN. I said no. After 5 phone calls, and maybe 2 hours with them, I got at least 8 different prices for the basic removal of the teeth with no complications. We need to know what it costs when the doctor steps into the room, and looks at the chart, and walks out again, and we need to know in advance. Unless this is a life or death emergency, I would and have prohibited any random 'health professional' from seeing me. Not only will transparency show where there are savings, it will also foster competition.

8. Either single billing, or independent billing but not both/all. From one emergency room visit, I've gotten bills from at least 6 different places. including one collections agent after 15 months! And that from a guy who wasn't even practicing at the hospital when I was admitted. Nice try...

9. Insurance offerings. We need a product that will offer catastrophic coverage, and have a high/medium deductible at low cost. I want to be able to pay cash for setting a simple broken leg(not compound femur, with pins, and vascular damage of course). I want to be able to pay cash for an office visit with a chest pic. Then, when my headache turns into a tumor in the stem of my head, I have insurance that I can rely on to cover the big, ugly stuff.
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That was my plan and it was working perfectly.... Till.. Obamacare..:mad2::mad2::mad2:
 
docmirror said:
We need to know what it costs when the doctor steps into the room, and looks at the chart, and walks out again, and we need to know in advance. Unless this is a life or death emergency, I would and have prohibited any random 'health professional' from seeing me. Not only will transparency show where there are savings, it will also foster competition.
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Some insurers tried to do this and made the patients aware what the cost is going to be for things like routine visits or sick kid visits. They saw utilization go up once people realized how cheap the services of a physician come after insurance repricing kicks in.


Once a year I have to pay $125 to a local plumber to check the backflow valve on my sprinklers. It would take the sprinkler guy 5 minutes to do it as part of his annual service, but no, you need a plumbing license to do this. Including travel, he can do about 15 of these in a day. Now that is a racked I want to get in on. As it is a mandated service, all the local plumbers have colluded to fix the price, so no market at work.
 
weilke said:
Some insurers tried to do this and made the patients aware what the cost is going to be for things like routine visits or sick kid visits. They saw utilization go up once people realized how cheap the services of a physician come after insurance repricing kicks in.


Once a year I have to pay $125 to a local plumber to check the backflow valve on my sprinklers. It would take the sprinkler guy 5 minutes to do it as part of his annual service, but no, you need a plumbing license to do this. Including travel, he can do about 15 of these in a day. Now that is a racked I want to get in on. As it is a mandated service, all the local plumbers have colluded to fix the price, so no market at work.
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combine pricing with the high deductible, or let the customer(patient) pay a high premium with a low deductible, then they can go in for every hangnail problem they want. As long as the premiums cover the process, I got no problem with it. Right now, there's zero transparency on pricing, and no high deductible low premium insurance product offered(he said, trying to stay non-political).
 
docmirror said:
combine pricing with the high deductible, or let the customer(patient) pay a high premium with a low deductible, then they can go in for every hangnail problem they want. As long as the premiums cover the process, I got no problem with it.
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The only way to make the customer price sensitive is by requiring up-front payment at the time of service. The way it works now that the bills go out only after insurance has paid and repricing occurs just puts the pain so far away from the pleasure that customers dont make the connection. If I can pick up my car after extensive accident repairs and receive an itemized bill at the time of service, we should be able to do the same in medicine.


Right now, there's zero transparency on pricing, and no high deductible low premium insurance product offered(he said, trying to stay non-political).
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The insurers dont make it easy for the patient to find out what the re-priced out of pocket expense is. Until patients start dumping plans that hide the pricing that wont change.
 
weilke said:
And often between the patient and their crazy family. If you are old and sick, the worst thing that can happen to you is a hospital visit from the out of state kid that only comes around every 6 months but insists that 'everything has to be done'.
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Now take that out of state kid who happens to be a 1st year resident, or a nurse, or an aide... who shows up late in the game and questions everything thats been done so far, and starts telling us how to practice..

We usually have one in attendance any given day on our unit.
 
Doggtyred said:
Now take that out of state kid who happens to be a 1st year resident, or a nurse, or an aide... who shows up late in the game and questions everything thats been done so far, and starts telling us how to practice..
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I have joked that the highest risk-factor for something going wrong is having an out of state daughter with a nursing PhD.
 
weilke said:
I have joked that the highest risk-factor for something going wrong is having an out of state daughter with a nursing PhD.
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A family member with some type of medical background who lives out of state occurs with some regularity.

We also have a saying "Beware of a nurse with a briefcase."
Either of these situations can make a physician's life miserable.
 
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