The highest paid health care workers aren't...
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The guy running the hospital, responsible for everything, shouldn't make as much as one of his doctors?
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Bob Noel
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At first blush, it would appear that the comparison is flawed. Comparing average doctor pay (including 1st year docs) to a job category like hospital administrator neglects the reality of career path. Are there any hospital administrators with little experience right out of college?
Is the highest paid doctor in the US paid more than the highest paid hospital administrator?
dnhill
Pre-Flight
Yes, he/she should. The administrator must be an expert in all aspects of running a business, including all of the incredible legal complexity of local, state, and federal regulations. In many communities, the hospital(s) is/are the largest employer.
For full disclosure, I just retired from running a hospital. I was also a nurse. Because I wanted to make more money, I decided to go back to school in order that I could run hospitals. Two degrees later (I ended up having as much education as the physicians) I was able to get a job running a hospital.
I don't understand the media's preoccupation with comparative salary issues.
As an aside, Obamacare is going to hurt the average person's access to healthcare.
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well, yeah, that was my point. The CEO should be making at least as much as his doctors.
JoseCuervo
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I'll bite.
How?
Still the same number of Dr's in the country, still the same number of people.
Math is an average, so People/Dr is the same.
Only way is Dr's choose to see fewer people and provide less care, or we start increasing the number of bodies.
(other way, is that now people finally getting access to healthcare start showing up to have diseases treated that were previously killing them.)
woodstock
Final Approach
At least as much, sure. Even a (small) multiple, sure.
This kind of reminds me of airline companies/pilots (except the discrepancy isn't as high). Without pilots, there would be no airline - and yet they get squeezed and the CEOs rake it in regardless of how poorly the airline is doing.
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Bob Noel
You have assumed facts not in evidence.
JoseCuervo
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You are right, 3 old Dr's died today.
8 new babies were born today.
Did that change the "average"?
JOhnH
Touchdown! Greaser!
More and more doctors are giving up practice and retiring early.
Doctors are spending more and more time trying to follow regulations and are spending less time seeing patients.
Fewer and fewer people can afford to attend medical school.
If you sign up millions more people via Obamacare, then the reduced number of doctors seeing more and more patients = decline in docs/patient.
I don't know if my statements are true or not; I believe they are, but this IS the spin zone.
Bill Watson
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This isn't the spin zone is it? I'm not signed up for the spin zone. What is "Confidential Subjects"?
JoseCuervo
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I watch a lot of old Westerns. Love the Shootist with John Wayne, Lauren Becall, and Jimmy Stewart as the Dr. Seems like the Dr. had to spend a bit of time making house calls as his cancer progressed.
Do you really think Dr's spend less time seeing patients now than they did when they had to travel via horse and buggy? It is all perspective.
I would love to see "real" numbers on this exodus of Dr's retiring early. I just don't see it. I have an "old" Dr that lives a few doors down from me. He just bought a new set of boobs for his new nurse, and, then a new house as, for some reason, his old wife no longer thought they should live in the same house. I just don't see him retiring any time soon.
(As an aside, a bunch of the other Dr's I know are all sitting on big piles of cash as they sold their practices to the local hospitals for a a bundle, now get to just practice medicine and don't have to worry about collecting from insurance companies, uninsured deadbeats, or any of the other nonsense. They seem happier than hell, see above Old Dr with New Nurse with New Boobs).
Do you have any data on fewer and fewer being able to afford and attend Med School? I know our state (one without a med school) just authorized more $$$$ to fund more seats at the neighboring state's Med School. Are there actually seats, that you are aware of, in Med Schools that are lacking bodies?
This is the one that always bothers me. Was there something about the old system that you liked, where the "more and more patients" who did not have insurance were unable to get healthcare?
rbridges
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I don't have answers, but I can pose a couple of "Ifs." If the coverage is terrible, and doctors opt out of it, it could make finding one more difficult and increase time to be seen. also, the insurance could limit allowed procedures to keep costs down. I guess we'll have to wait and see.
I have worked with hospital CEOs who were worth every $$ they were being paid. The absolute number was tiny relative to the budget of the organization.
Where the fat that can be trimmed is located is at the VP level. How many executive vice presidents of jello safety do we really need ? Most of them are glorified supervisors and spend most of their day scheming on how to increase their headcount and budget.
Where the fat that can be trimmed is located is at the VP level. How many executive vice presidents of jello safety do we really need ? Most of them are glorified supervisors and spend most of their day scheming on how to increase their headcount and budget.
nddons
Touchdown! Greaser!
Let's not forget that the rise in non-wage compensation for top executives in public companies (see article for insurance company CEO compensation) came about in the 1993 Omnibus Budget Reconciliation Act. Clinton wanted to limit the deduction for executive compensation to $1 million. So, companies figured out how to compensate their execs with non-wage compensation.
The law of unintended consequences.
The law of unintended consequences.
He should make $1 less than the next qualified guy willing to do the job.
CEO salary should have nothing to do with doc salaries, in most cases he is not their boss anyway. When I worked for a 25 bed hospital, the CEO made a lot less than I did. Now I work for a 2000bed health system and the CEO makes more than all but one or two physicians.
JoseCuervo
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Maybe, but, one would also argue that NOT having insurance and being uninsured was "even more terribler" and doctors routinely opted out of seeing patients who had no insurance (or knew they were not getting paid.)
Insurance companies have long limited what was allowed. That is nothing new. We probably don't need to "wait and see" to know that insurance companies don't like paying for treatment. I think we have the past 30 years of data that shows us.
I have always figured that more people having insurance is better than fewer people having insurance.
And, I have always figured we have to provide medical care to 100% of our population. And, if we can treat stuff early and proactively, far better than neglecting it (due to lack of insurance) until it becomes an item in an Emergency Room, which is more expensive.
I consider myself "average", and, my Dr still works in the same office, still wears the same lab coat, still has the same employees. He still takes my same insurance card, and, I still pay the same $40 co-payment. He still calls prescriptions into the same pharmacy. I can't see where anything has changed in my "average" experience.
(Now, the part that WILL change, is, my insurance costs will go up!!! Just like they have every year for the past 20 years, or more. So, I guess that really isn't a change.)
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I never said it did, but my point was more to counter the thought of hospital top management making as much as or more than the top doctors.
Jim Logajan
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If it works as designed, it increases the number of patient-hours while it does nothing to increase the number of doctors.
Previously, under-insured and uninsured could not afford to see a doctor until things got critical.
Cost containment measures of ACA could, in theory, reduce the number of doctors entering practice.
Patient-hours/Dr should in theory be larger when all factors of ACA are taken into account. No aspect of ACA appears to be directed at increasing the number of doctors or reducing the number of patient hours. The sole goal appears to have been universal coverage.
The ACA was by design intended to subsidize access to health care by increasing the cost to everyone who already could afford health care insurance. Yes, it tries to also contain costs via centralized cost-control regulations, but fundamentally it is a realization of the maxim "from each according to his ability [to pay] to each according to his need [for health care]."
dnhill
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The insurance plans that have been presented to the physicians that are designed for the Accountable Care Act (Obamacare) tend to have lower reimbursement to the physicians. The cost of running a practice will not go down, therefore the physician has to do a cost/benefit analysis to determine if he will sign up for the plans. We have already seen this type of behavior in the Medicare patient population. Fewer physicians are now treating Medicare patients due to the amount Medicare pays for such care.
http://www.kaiserhealthnews.org/daily-reports/2013/july/29/medicare-doctor-issues.aspx
This at a time when there are more Medicare beneficiaries then ever before.
JoseCuervo
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I am not sure anyone ever thought it was supposed to increase the supply of Dr's. If we had a shortage before, we still have a shortage. If we had a surplus before, we still have a surplus. From a Macro standpoint, 100% of this nation's Drs were responsible for providing 100% of the healthcare. That has not changed.
Which was a horrible way to deliver healthcare. Emergency rooms are far more expensive than vaccines, offices, and clinics.
Don't Dr's get more time to see patients and deliver healthcare if they don't have to supervise their collections department?
Prior to this, I had to subsidize every uninsured person's health care when they stiffed the hospital and the dr and didn't pay. That was a "from each according to his ability [to pay] to each according to his need [for health care]." type of model. And terribly inefficient.
Not to mention the amount of my taxes that went to the County to pay for "indigent" healthcare. Are you arguing it is a better system for my tax dollars to go to the County fund?
JoseCuervo
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Doesn't Blue Cross and Blue Shield also try and lower the reimbursement of the non-Obamacare plans? That principle hasn't changed for the last 20 years.
JohnF
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Medical care is an economic good. It takes human effort to produce it. For an interesting thought experiment, remove economic motive for production and then figure out how any government will make it exist.
So, I'll paraphrasing what you have said; I have always figured we have to provide [pick any economic good] to 100% of our population.
Could the statement be: I have always figured we have to provide [all economic goods] to 100% of our population?
What if someone else thinks that the economic good should be C172s?
How does putting a middleman (insurance) between the producer (doctor) and consumer (patient) reduce the cost of the product (health care)?
JohnF
Pre-Flight
Fun with numbers huh.
It will always be the case that 100% of the doctors will provide 100% of the healthcare. Even when there are no doctors.
You are missing something, don't you think?
jtheune
Ejection Handle Pulled
Since when did have the highest education level ever guarantee you the highest salary?
I would argue the article is flawed because it measures the salary of the CEO or the top of the heap to Doctors which are employees of which there are many at a hospital.
JoseCuervo
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For some reason, every time a house in my neighborhood catches fire, the government makes a fire truck appear and provide me "fire care".
Check the Farm Bill, but we sure seem to want to provide soybeans, corn, and milk to 100% of our population.
You can make imaginary statements however you want.
Why would anyone want a bunch of 172s if they don't have medicals due to substandard healthcare? Ramp queens.
You might ask Harry Truman and his implementation of some sort of tax benefits to tie health insurance to employers via tax tax breaks. For whatever reason, the US likes a system where we put insurance middlemen between Drs and their patients. That is why they have "pre-admission reviews" and have had for decades. Nothing new here....
Gary F
Final Approach
Yea but if you increase the demand for health care services it would be good to increase the capacity of the system.
Terll me what you make of this.
Giving poor people health insurance, the belief was, would decrease their dependence on hospital emergency rooms by providing them access to more appropriate, lower-cost primary care.
But a study published in the journal Science on Thursday finds that's not the case. When you give people Medicaid, it seems they use both more primary care and more emergency room services. http://www.npr.org/blogs/health/201...nsion-boosted-emergency-room-visits-in-oregon
We never "supervised" collections. The problem is meeting the documentation requirements that each payor required.The government (CMS) is continually making this much more difficult.
Now we are providing more healthcare which must be subsidized.
How does the ACA help this? The best approach would be to quit crippling the economy so we had fewer indigent people but the current administration is dead set against this option.
JohnF
Pre-Flight
Bummer. I was hoping for a good conversation.
JOhnH
Touchdown! Greaser!
JohnF
Pre-Flight
Oops, my bad too. I didn't know about the spin zone.
Gary F
Final Approach
The subsidies will get even bigger with ObamaCare.
Health insurance companies are poised to have access to billions of taxpayer dollars in what Republicans are calling an Obamacare 'bailout.'
In a little-noticed regulation issued late last week, the Department of Health and Human Services authorized massive payments to insurers that lose money because of the Affordable Care Act's requirement that they cover even the oldest and sickest Americans.
A provision of the Obamacare law known as 'risk corridors' provides the safety valve for insurance companies if they keep rate hikes modest but still wind up in the red.
According to that system, insurers whose claims in 2014 are 3 per cent higher than what was projected will recover half of the different from the government.
If claims are 8 per cent or more above projections, taxpayers cover 80 per cent of the company's losses.
Health insurance companies are poised to have access to billions of taxpayer dollars in what Republicans are calling an Obamacare 'bailout.'
In a little-noticed regulation issued late last week, the Department of Health and Human Services authorized massive payments to insurers that lose money because of the Affordable Care Act's requirement that they cover even the oldest and sickest Americans.
A provision of the Obamacare law known as 'risk corridors' provides the safety valve for insurance companies if they keep rate hikes modest but still wind up in the red.
According to that system, insurers whose claims in 2014 are 3 per cent higher than what was projected will recover half of the different from the government.
If claims are 8 per cent or more above projections, taxpayers cover 80 per cent of the company's losses.
Blackhawk
Pre-takeoff checklist
“Socialism, like the ancient ideas from which it springs, confuses the distinction between government and society. As a result of this, every time we object to a thing being done by government, the socialists conclude that we object to its being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say that we want no religion at all. We object to a state-enforced equality. Then they say that we are against equality. And so on, and so on. It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.”
― Frédéric Bastiat, The Law
JoseCuervo
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Not sure that the country's population has changed significantly in the last 6 months, so we should likely still have the same demand.
Do you think we used to cover everybody before, or, did we have some system that excluded people by design?
From the last line of your article. Spot on.
Really? I knew a gal that worked with 3 other collectors in a busy surgical group, chasing insurance companies and patients for money. They had a partner/Dr who was in charge of them and the rest of the Office Staff, including the Office Manager.
Also knew some people who were involved in takiing over clinics when the hospital bought them. They would go back the last X-months and start sending out bills that the Clinic had ignored/forgotten/neglected. Every clinic they bought had a ton of money owed that they should have previously supervised.
Who are we providing the "more healthcare" to? People that just showed up? Or, are they the people who were clogging the emergency rooms and spreading diseases thru our schools and airline flights?
Are you somehow thinking the previous administration losing 500k-700k jobs per month was a good thing? Would you happen to know how many jobs have been created in this economy since Jan 2009 vs those that were lost prior to Jan 2009?
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JoseCuervo
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Why is fire protection different than healthcare?
Could both be delivered with similar economic models?
Gary F
Final Approach
Blackhawk
Pre-takeoff checklist
The idea that a federal government, especially one in a mass the size of the US can run something such as health care efficiently is one of the most absurd thoughts I have ever heard expressed. Just look at the millions (if not billions), wasted on the websites, both federal and state. I probably could have gotten a few teens from my kid's high school to do a better job for pizza money. The solution? Let's throw more money at it.
I have actually run a federal budget. Let me explain to people in simple terms how it works.
You have two teenagers going to the mall for 1 hour. You give them each $100 with the following stipulations:
1. If they return any money they will have that much less money the next time they go to the mall. For example, if they only spend $80 that is all you will give them next time.
2. If one of them spends all of their money before the allotted hour you will take money from the other teen to make up for it.
3. The next time they go to the mall the teen who spent too much money will get that much more money.
4. Every time they go to the mall they will get at least 5% more money as long as they spent all their money the last time they went to the mall. Any decrease in this 5% will be presented as a "budget cut" for the family budget.
Someone made the case for the government providing fire service... as if the government is the only way fire service can provided. We have private doctors and hospitals that are MUCH more efficient and provide better care than the VA... why not private fire departments. Denmark (much more socialist than us), uses a private company called Falk to provide over 65% of their fire service. I don't seem to hear of Danes burning by the droves.
Most of the good intentions of socialists have resulted in fiascos. The Department of Education, Department of Energy.. heck, even the Department of Defense even though that is the one true role of a government.
My wife as an orthopeadic surgeon has experienced first hand the fiasco of Obama Care. Federal inspectors from DC were VERY concerned that some of the pictures and diplomas in her office were less than 12" from the ceiling. Little care that she spend hours each day trying to enter the correct code for patients instead of seeing patients.
I have actually run a federal budget. Let me explain to people in simple terms how it works.
You have two teenagers going to the mall for 1 hour. You give them each $100 with the following stipulations:
1. If they return any money they will have that much less money the next time they go to the mall. For example, if they only spend $80 that is all you will give them next time.
2. If one of them spends all of their money before the allotted hour you will take money from the other teen to make up for it.
3. The next time they go to the mall the teen who spent too much money will get that much more money.
4. Every time they go to the mall they will get at least 5% more money as long as they spent all their money the last time they went to the mall. Any decrease in this 5% will be presented as a "budget cut" for the family budget.
Someone made the case for the government providing fire service... as if the government is the only way fire service can provided. We have private doctors and hospitals that are MUCH more efficient and provide better care than the VA... why not private fire departments. Denmark (much more socialist than us), uses a private company called Falk to provide over 65% of their fire service. I don't seem to hear of Danes burning by the droves.
Most of the good intentions of socialists have resulted in fiascos. The Department of Education, Department of Energy.. heck, even the Department of Defense even though that is the one true role of a government.
My wife as an orthopeadic surgeon has experienced first hand the fiasco of Obama Care. Federal inspectors from DC were VERY concerned that some of the pictures and diplomas in her office were less than 12" from the ceiling. Little care that she spend hours each day trying to enter the correct code for patients instead of seeing patients.
Gary F
Final Approach
People who get "free" anything tend to be less selective in it's use. The amount of elective and unnecessary healthcare will increase along with the appropriate healthcare.
Part of my job is educating people on medical matters and sometimes it can be frustrating. In many cases they care more about convenience than appropriateness. Those of us who actually intend to pay the co-pays may be a little more responsible than those who have highly subsidized healthcare.
I suspect we had much better staff.
I'm not sure what you are getting at and to me this seems a little ridiculous.
Obama took a temporary economic cycle and made it permanent. No recovery for us, at least not a meaningful one.
JohnF
Pre-Flight
Fire protection is an economic good. It takes human effort to produce. The government does not make it exist. So far there is economic motive to becoming a fireman. Although in your case a firetruck will roll to your door when in need, this is not the case for 100% of our nations' population.
Your analog missed the thought experiment by such a distance as to seem to me to be either a deliberate attempt to redirect the debate with a straw man or a closed minded defense showing lack of thought.
So, how does the government "make" doctors or firemen?
Now that I know about the spin zone I feel uncomfortable with this discussion under Medical Topics. I would move it if I could.
JoseCuervo
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What agency were they from?
What regulation were they concerned with?
Can you provide of a link that details the distance a diploma must be from a ceiling tile?
JoseCuervo
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These people were getting it "free". They didn't pay when they went, they left hospital bills and Dr bills to be paid for by the rest of us who had insurance and who paid taxes.
And, won't these insurance companies start eliminating unnecessary procedures? You know, those industry based death panels? If it is unnecessary and elective, the insurance company will deny. Seems like what you would want???
Education is important. Don't get discouraged, keep at it.
This particular hospital has bought up dozens of clinics, the person I was discussing it with said they were all mismanaged on payables. Lots of cash was out there for the acquiring hospital to grab, it was part of the strategy.
People who don't get preventative treatment cost us more long term. Look at the outbreaks of diseases now happening because people aren't getting vaccines. What percentage of ER visits could have been prevented with earlier treatment in a clinic? 1% or 5% or 20%?
He took a recession and has made a permanent recovery? That seems like a good thing.
How old were you in August - October of 2008? Do you remember watching the car dealers folding? Do you remember watching the stock market crashing? Do you remember watching the job lay-offs announced each night on the evening news?
Do you see any of the above these days?