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Posted: 8/4/2015 3:00:49 PM EDT
[#1]
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Some insight from a neighbor who's a hospital administrator: Increasingly, hospitals are being assigned groups of people (from the government health exchange networks I expect) that they are responsible for within the local community. It's a sort of risk pool of healthy people, average people, unhealthy people, and really unhealthy people. Depending on how each person is classified, the hospital is given a sum of money each month. For a healthy person in the risk pool, the hospital might receive $200/month while the hospital might receive $1100/month for a really unhealthy person like an obese diabetic alcoholic or such. Then the hospital is completely responsible for providing care to all those in their pool of assigned patients. If it costs the hospital less to treat a patient than the money the hospital receives each month, the hospital makes money. If it costs more to treat someone than the money the hospital receives, the hospital loses money. It's up to the hospital to find creative ways to save on the cost of treating patients. My first question upon hearing about this was, "Doesn't this incentivize the hospital to withhold treatment?" The reply the hospital administrator gave was, "Well, yes. But the hospital is also supposed to be compensated based on patient satisfaction. So that is supposed to balance the incentives." Yeah.  
The administrator also commented that, "Americans are going to have to give up on the expectation of getting treatment just because they can afford it." Healthcare is going to be rationed. it will depend on who you know, who you are, there will not be rationing for certain people |
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Posted: 8/4/2015 3:05:22 PM EDT
[#2]
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When you make your move to the Caribbean, please post it here. I'd like to apply with your new practice. Honestly, I am looking forward to cruise ships converting to floating hospitals, and elective surgery centers. Posted Via AR15.Com Mobile Quote HistoryQuoted:
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Why... it's almost exactly as I predicted it would be. It's almost like I do this for a living. Oh... wait... I do.
 When you make your move to the Caribbean, please post it here. I'd like to apply with your new practice. Honestly, I am looking forward to cruise ships converting to floating hospitals, and elective surgery centers. Posted Via AR15.Com Mobile Those boats are a floating infection pool now and they are full of "healthy" people. |
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Posted: 8/4/2015 3:11:34 PM EDT
[#3]
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Well I'm pretty fond of my wife the NP. Her patients are also pretty fond of her work also. I can talk medical fuck ups all day that MDs do also. Like the time a surgeon refused to do a sponge count at the end of a surgery. Yup you guessed it, emergency surgery a day later to I've the lost sponge.
Or the time my wife refused to allow a surgery start until the all the staff was present and quite for the time out. This is when everyone in the surgery suite discusses what the procedure is and how it will go. The surgeon was pissed that this nurse, she was a nurse at the time, had the nerve to make him participate in this. I fucking know what I'm doing he screamed and he stopped around the room throwing shit and generally acting like a spoiled child. You guessed it he was prepping to remove the wrong kidney.
Or one of the sixteen billion times she called a code, only to have a intern or doctors respond with "What would you do ?" "Well just do that, that sounds good. "
Or the thre times last week where a ER doc gave on of her patients a medication that reacts negatively with other meda that the patient is already on.
Docs are like every profession. Some are awesome and some are just cashing a check. You should do a little Google research before you start talking shit about NPs. Their outcomes are statistically better than MDs and the cost is significantly less. But let's not let medical studies and facts get in the way of our little hate feat here. Quote HistoryQuoted:
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That explains why all the premed and medical school classes are completely empty.  lol They don't understand what they're getting themselves into. They only know medicine from watching House and reruns of ER. I've talked multiple people into avoiding medical school. If they absolutely want to do healthcare as a profession, I advise them to become a PA or ARNP. Well despite your efforts all the medical schools in the U.S. once again full with new med students. As far as NPs go, they are the future of primary healthcare. The days of making big bucks as a GP is gone for MDs. They have priced themselves out of the market. This has little to do with Ocare and ever thing to do with cost to benefit to cost ratio.
Affirmative action for one. Others so fucking stupid, lazy and entitled. One of them (not med student or intern but a resident--hung blood on a patient without checking it. 2 units. ) Another was asked if he had removed a certain tube from the patient's mouth---he didn't get out of chair "yes". Surgeon proceeded---lo and behold he had not removed the tube. Surgeon stapled across it.
I usually rant on the rotten nurses but the docs are going downhill fast. Well I'm pretty fond of my wife the NP. Her patients are also pretty fond of her work also. I can talk medical fuck ups all day that MDs do also. Like the time a surgeon refused to do a sponge count at the end of a surgery. Yup you guessed it, emergency surgery a day later to I've the lost sponge.
Or the time my wife refused to allow a surgery start until the all the staff was present and quite for the time out. This is when everyone in the surgery suite discusses what the procedure is and how it will go. The surgeon was pissed that this nurse, she was a nurse at the time, had the nerve to make him participate in this. I fucking know what I'm doing he screamed and he stopped around the room throwing shit and generally acting like a spoiled child. You guessed it he was prepping to remove the wrong kidney.
Or one of the sixteen billion times she called a code, only to have a intern or doctors respond with "What would you do ?" "Well just do that, that sounds good. "
Or the thre times last week where a ER doc gave on of her patients a medication that reacts negatively with other meda that the patient is already on.
Docs are like every profession. Some are awesome and some are just cashing a check. You should do a little Google research before you start talking shit about NPs. Their outcomes are statistically better than MDs and the cost is significantly less. But let's not let medical studies and facts get in the way of our little hate feat here. you got all that from the internet and are passing it off as first hand knowlege.... how clever |
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Posted: 8/4/2015 3:13:16 PM EDT
[#4]
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I expect that to become illegal. Quote HistoryQuoted:
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Lots of practices around here are dumping medicaid/state insurance. I expect that to become illegal. 2 Words. Patient abandonment. |
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Posted: 8/4/2015 3:19:16 PM EDT
[#5]
Quoted:However, Hieb added, it will be the less affluent areas and those that don't have private insurance that will feel the pinch first. Her recommendation to avoid having to deal with these problems and "save yourself" from the coming horrors of Obamacare is to get yourself healthy enough so that you won't need a doctor in the first place. LMFAO. Remember how the left was busting McCain's balls in 2008 about how his healthcare plan for the nation was "Don't get sick?" Sounds awfully a lot like their advice now. Fucking assholes. |
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Posted: 8/4/2015 3:30:48 PM EDT
[#6]
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Thanks I hadn't heard that....... I wont be sleeping again for awhile. I can only keep 1 month on hand. Quote HistoryQuoted:
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There's a lot of Dr's folding their practice (most general practitioners) or selling out to hospital/conglomerates too because of the new ICD10 standards and the cluster of a roll-out it's having with their billing software, Medicare/Medicare and the private ins companies software. I know several MD's that sold their private practice recently and became salaried staff because with the new billing standards it was very likely 90% of their claims wouldn't be able to be billed starting in Sept/Oct until after Jan 1, 2016 and then actually paid until March/April 2016. They didn't have the cash reserves to keep the doors open for 6 months with how bad reimbursement rates are anymore. They've warned us to have 6 months of cash reserves in hand for ICD10. I've only been in private practice 3 years. I'll have to take out a loan of they can't get their shit together. Thanks I hadn't heard that....... I wont be sleeping again for awhile. I can only keep 1 month on hand. I don't think anybody has that much. I can't imagine any small business could run for 6 months with no income. I'm always hoping they will punt for another year again. I doubt that's the case though, but I'm hoping the extra year has given everyone from EMR to clearinghouses to Medicare time enough to really be ready. |
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Posted: 8/4/2015 3:40:58 PM EDT
[#7]
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My sister in laws husband is(was) an orthopedic surgeon. NOT ANY MORE. Retired 6 months ago. Said medicine changed so much in the last 4 years he sold his practice and got out. He knew when he dreaded coming to the office everyday that was his cue. Was making about 400k/year in his early 50's but worked his ASS off. He never even made a dollar until early 30's with school and internships. Ain't no one got time for that shit now. With $250k annual insurance, insane amounts of debt, long hours, and everything that comes with the hazards of the profession, there is hardly any incentive anymore to become a doctor, and lots of penalties that even the dumbest among us can recognize. |
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Posted: 8/4/2015 3:55:45 PM EDT
[#8]
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Well you can keep your doctor...unless he is now a lawyer or other well paid professional. Or he did the math and can live at that little vacation house he bought in the Bahamas for the rest of his life if he retired early. |
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Posted: 8/4/2015 5:31:31 PM EDT
[#9]
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There are 3,500 Neurosurgeons currently practicing, 1 for about every 82,000 people. Quote HistoryQuoted:
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Lost my regular Dr., he said fuck it and closed up shop. Was calling around for a new one and was rejected by almost every one till I said I had insurance from my job and cash. Then it was a fight over me  , I just need to find the best one out of those I called now.
It really sucks that my neurologist quit as well as I liked him and itsa bitch to find one that will take me as a new patient. Its really going to suck in the next few years when more and more are dropped by their drs I really like my neurosurgeon as well. He fixed a serious back injury for me and I am effectively 100% recovered. He's an older guy though, even without Obamacare I know he'll retire soon. Just hope I don't get messed up in my back again There are 3,500 Neurosurgeons currently practicing, 1 for about every 82,000 people. In other words, I'll never be doing squats at the gym again and I'll just tell everyone I'm on a permanent 10 lbs lifting limit, just to avoid re-rupturing my L4-L5 again. |
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Posted: 8/4/2015 5:35:02 PM EDT
[#10]
Quote HistoryQuoted: Well I'm pretty fond of my wife the NP. Her patients are also pretty fond of her work also. I can talk medical fuck ups all day that MDs do also. Like the time a surgeon refused to do a sponge count at the end of a surgery. Yup you guessed it, emergency surgery a day later to I've the lost sponge. Or the time my wife refused to allow a surgery start until the all the staff was present and quite for the time out. This is when everyone in the surgery suite discusses what the procedure is and how it will go. The surgeon was pissed that this nurse, she was a nurse at the time, had the nerve to make him participate in this. I fucking know what I'm doing he screamed and he stopped around the room throwing shit and generally acting like a spoiled child. You guessed it he was prepping to remove the wrong kidney. Or one of the sixteen billion times she called a code, only to have a intern or doctors respond with "What would you do ?" "Well just do that, that sounds good. " Or the thre times last week where a ER doc gave on of her patients a medication that reacts negatively with other meda that the patient is already on. Docs are like every profession. Some are awesome and some are just cashing a check. You should do a little Google research before you start talking shit about NPs. Their outcomes are statistically better than MDs and the cost is significantly less. But let's not let medical studies and facts get in the way of our little hate feat here. Quote HistoryQuoted: Quoted: Quoted: Quoted: Quoted: That explains why all the premed and medical school classes are completely empty. lol They don't understand what they're getting themselves into. They only know medicine from watching House and reruns of ER. I've talked multiple people into avoiding medical school. If they absolutely want to do healthcare as a profession, I advise them to become a PA or ARNP. Well despite your efforts all the medical schools in the U.S. once again full with new med students. As far as NPs go, they are the future of primary healthcare. The days of making big bucks as a GP is gone for MDs. They have priced themselves out of the market. This has little to do with Ocare and ever thing to do with cost to benefit to cost ratio. Affirmative action for one. Others so fucking stupid, lazy and entitled. One of them (not med student or intern but a resident--hung blood on a patient without checking it. 2 units. ) Another was asked if he had removed a certain tube from the patient's mouth---he didn't get out of chair "yes". Surgeon proceeded---lo and behold he had not removed the tube. Surgeon stapled across it. I usually rant on the rotten nurses but the docs are going downhill fast. Well I'm pretty fond of my wife the NP. Her patients are also pretty fond of her work also. I can talk medical fuck ups all day that MDs do also. Like the time a surgeon refused to do a sponge count at the end of a surgery. Yup you guessed it, emergency surgery a day later to I've the lost sponge. Or the time my wife refused to allow a surgery start until the all the staff was present and quite for the time out. This is when everyone in the surgery suite discusses what the procedure is and how it will go. The surgeon was pissed that this nurse, she was a nurse at the time, had the nerve to make him participate in this. I fucking know what I'm doing he screamed and he stopped around the room throwing shit and generally acting like a spoiled child. You guessed it he was prepping to remove the wrong kidney. Or one of the sixteen billion times she called a code, only to have a intern or doctors respond with "What would you do ?" "Well just do that, that sounds good. " Or the thre times last week where a ER doc gave on of her patients a medication that reacts negatively with other meda that the patient is already on. Docs are like every profession. Some are awesome and some are just cashing a check. You should do a little Google research before you start talking shit about NPs. Their outcomes are statistically better than MDs and the cost is significantly less. But let's not let medical studies and facts get in the way of our little hate feat here. Though I can go into Nurse hate at the drop of a hat. |
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Posted: 8/4/2015 6:24:49 PM EDT
[#11]
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Those boats are a floating infection pool now and they are full of "healthy" people. Quote HistoryQuoted:
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Why... it's almost exactly as I predicted it would be. It's almost like I do this for a living. Oh... wait... I do.
When you make your move to the Caribbean, please post it here. I'd like to apply with your new practice. Honestly, I am looking forward to cruise ships converting to floating hospitals, and elective surgery centers. Posted Via AR15.Com Mobile Those boats are a floating infection pool now and they are full of "healthy" people. Every place that's known as a tax haven will be offering specialized medical services/ surgeries. It's the wave of the future. |
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Posted: 8/4/2015 6:27:36 PM EDT
[#12]
This is no accident. Denial of medical services is part of the die-off plan.
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Posted: 8/4/2015 6:37:42 PM EDT
[#13]
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2 Words. Patient abandonment. Quote HistoryQuoted:
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Lots of practices around here are dumping medicaid/state insurance. I expect that to become illegal. 2 Words. Patient abandonment. Nope... You don't have to take that insurance. The patient can pay out of pocket and you can help them file with their insurance to get reimbursed.....you're not abandoning the patient, just not taking that insurance any more. Alternatively, you don't have to take new patients with that insurance. Yes, we're about do stop taking new Medicaid patients here in our practice for a long list of issues...low reimbursement, chronic no shows, etc. etc. |
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Posted: 8/4/2015 6:41:04 PM EDT
[#14]
"Minorities" already get preference for jobs, education, etc. They'll get preference for government controlled health care too, as sure as the sun rises.
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Posted: 8/4/2015 6:47:28 PM EDT
[#15]
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FBHO "Obama Care" Obama exempted himself from this "care".
Does anyone know what percentage of MD's voted for Lord Obama? Oh, in 2012, Forbes had it at 36% voted for him, with 5% undecided. How in the hell could anyone be "undecided" on Obama? Shades of the coal miners voting for the guy who wrecked their industry. |
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Posted: 8/4/2015 8:46:53 PM EDT
[#16]
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Would you like to buy an argument? Quote HistoryQuoted:
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Why... it's almost exactly as I predicted it would be. It's almost like I do this for a living. Oh... wait... I do.
So how well does making predictions on the internet pay , and where do I get an application? Would you like to buy an argument? Nah, I find them for free all the time. 
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Posted: 8/4/2015 8:53:05 PM EDT
[#17]
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Nope... You don't have to take that insurance. The patient can pay out of pocket and you can help them file with their insurance to get reimbursed.....you're not abandoning the patient, just not taking that insurance any more. Alternatively, you don't have to take new patients with that insurance. Yes, we're about do stop taking new Medicaid patients here in our practice for a long list of issues...low reimbursement, chronic no shows, etc. etc. Quote HistoryQuoted:
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Lots of practices around here are dumping medicaid/state insurance. I expect that to become illegal. 2 Words. Patient abandonment. Nope... You don't have to take that insurance. The patient can pay out of pocket and you can help them file with their insurance to get reimbursed.....you're not abandoning the patient, just not taking that insurance any more. Alternatively, you don't have to take new patients with that insurance. Yes, we're about do stop taking new Medicaid patients here in our practice for a long list of issues...low reimbursement, chronic no shows, etc. etc. God I wish my wife's practice would do that.
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Posted: 8/4/2015 8:53:19 PM EDT
[#18]
One of my Doctors (damn, am I that old?) is considering moving to New Zealand. Apparently there is a shortage of her specialty and it gets her out of this ACA crap. I don't blame her but I do like her and will hate to see her go.
A different doctor hasn't confided in me but from our conversations I do believe he despises it too. |
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Posted: 8/4/2015 8:56:35 PM EDT
[#19]
Quote HistoryQuoted: With $250k annual insurance, insane amounts of debt, long hours, and everything that comes with the hazards of the profession, there is hardly any incentive anymore to become a doctor, and lots of penalties that even the dumbest among us can recognize. Quote HistoryQuoted: Quoted: My sister in laws husband is(was) an orthopedic surgeon. NOT ANY MORE. Retired 6 months ago. Said medicine changed so much in the last 4 years he sold his practice and got out. He knew when he dreaded coming to the office everyday that was his cue. Was making about 400k/year in his early 50's but worked his ASS off. He never even made a dollar until early 30's with school and internships. Ain't no one got time for that shit now. With $250k annual insurance, insane amounts of debt, long hours, and everything that comes with the hazards of the profession, there is hardly any incentive anymore to become a doctor, and lots of penalties that even the dumbest among us can recognize. |
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Posted: 8/4/2015 10:25:17 PM EDT
[#20]
Quote HistoryQuoted:
Well I'm pretty fond of my wife the NP. Her patients are also pretty fond of her work also. I can talk medical fuck ups all day that MDs do also. Like the time a surgeon refused to do a sponge count at the end of a surgery. Yup you guessed it, emergency surgery a day later to I've the lost sponge.
Or the time my wife refused to allow a surgery start until the all the staff was present and quite for the time out. This is when everyone in the surgery suite discusses what the procedure is and how it will go. The surgeon was pissed that this nurse, she was a nurse at the time, had the nerve to make him participate in this. I fucking know what I'm doing he screamed and he stopped around the room throwing shit and generally acting like a spoiled child. You guessed it he was prepping to remove the wrong kidney.
Or one of the sixteen billion times she called a code, only to have a intern or doctors respond with "What would you do ?" "Well just do that, that sounds good. "
Or the thre times last week where a ER doc gave on of her patients a medication that reacts negatively with other meda that the patient is already on.
Docs are like every profession. Some are awesome and some are just cashing a check. You should do a little Google research before you start talking shit about NPs. Their outcomes are statistically better than MDs and the cost is significantly less. But let's not let medical studies and facts get in the way of our little hate feat here. If you think most NPs are better than a doc for a sick group of patients (particularly the very sick), you're f*cking delusional. You can become an NP with only six years of training (BSN + two years). That doesn't exactly compare favorably to a physicans minimum of eleven years. Sorry... I get that your wife is one, and you're proud/fully-invested in her worldview, but get back to me when they do a dozen years of training before being allowed to run their own show. And I'm a supporter of NPs. We employ multiple extenders, and they're fantastic... but they also know their limitations. That latter point is the MOST important trait for an extender to have; knowing when to call for help. For much of what I see in the ER (the run-of-the-mill CHF, chest pains, basic fractures, etc) they do just as good a job as I do... but for that 10% of patients that are really sick/complicated/unstable, they need me. |
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Posted: 8/4/2015 10:28:08 PM EDT
[#21]
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They've warned us to have 6 months of cash reserves in hand for ICD10. I've only been in private practice 3 years. I'll have to take out a loan of they can't get their shit together. Quote HistoryQuoted:
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There's a lot of Dr's folding their practice (most general practitioners) or selling out to hospital/conglomerates too because of the new ICD10 standards and the cluster of a roll-out it's having with their billing software, Medicare/Medicare and the private ins companies software. I know several MD's that sold their private practice recently and became salaried staff because with the new billing standards it was very likely 90% of their claims wouldn't be able to be billed starting in Sept/Oct until after Jan 1, 2016 and then actually paid until March/April 2016. They didn't have the cash reserves to keep the doors open for 6 months with how bad reimbursement rates are anymore. They've warned us to have 6 months of cash reserves in hand for ICD10. I've only been in private practice 3 years. I'll have to take out a loan of they can't get their shit together. I work on the insurance side of healthcare financing and ICD10 makes me want to shoot myself. what a fucking mess. |
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Posted: 8/4/2015 10:31:04 PM EDT
[#22]
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I don't think anybody has that much. I can't imagine any small business could run for 6 months with no income. I'm always hoping they will punt for another year again. I doubt that's the case though, but I'm hoping the extra year has given everyone from EMR to clearinghouses to Medicare time enough to really be ready. Quote HistoryQuoted:
I don't think anybody has that much. I can't imagine any small business could run for 6 months with no income. I'm always hoping they will punt for another year again. I doubt that's the case though, but I'm hoping the extra year has given everyone from EMR to clearinghouses to Medicare time enough to really be ready. It hasn't, but they're moving ahead anyway. at least they're throwing this bone, not that it will help with all of the IT system problems in dealing with the new codes that haven't been fixed yet: http://www.medscape.com/viewarticle/847617 In a significant concession to organized medicine, the Medicare program yesterday announced a 1-year grace period for claims bearing the fastidious ICD-10 diagnostic codes that go into effect October 1. Here's the grace: Claims won't be rejected for payment simply because the ICD-10 code submitted isn't specific enough. ... CMS also said that if its claims-processing contractors are unable to process Medicare claims bearing the new codes because of problems on their end, physicians can ask for partial advance payments. ... here's the cms letter discussed in that article: https://www.cms.gov/Medicare/Coding/ICD10/Downloads/MedicareProviderICD-10.pdf |
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Posted: 8/4/2015 10:32:54 PM EDT
[#23]
Quote HistoryQuoted: Catastrophic Injury Insurance Policy: http://i.imgur.com/AzG1Lhbl.jpg America wanted 3rd world health care, they voted for it twice. Obama made his intentions clear in 2007 but the masses couldn't be bothered to spend 5 minutes actually researching the man. America elected a Muslim president twice. Now America is giving nuclear weapons to radical Muslims. What could possibly go wrong? It's not like those peaceful Muslims would attack America. |
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Posted: 8/5/2015 7:43:16 AM EDT
[#24]
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Nope... You don't have to take that insurance. The patient can pay out of pocket and you can help them file with their insurance to get reimbursed.....you're not abandoning the patient, just not taking that insurance any more. Alternatively, you don't have to take new patients with that insurance. Yes, we're about do stop taking new Medicaid patients here in our practice for a long list of issues...low reimbursement, chronic no shows, etc. etc. Quote HistoryQuoted:
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Lots of practices around here are dumping medicaid/state insurance. I expect that to become illegal. 2 Words. Patient abandonment. Nope... You don't have to take that insurance. The patient can pay out of pocket and you can help them file with their insurance to get reimbursed.....you're not abandoning the patient, just not taking that insurance any more. Alternatively, you don't have to take new patients with that insurance. Yes, we're about do stop taking new Medicaid patients here in our practice for a long list of issues...low reimbursement, chronic no shows, etc. etc. Just wait until your state license is tied to Medicaid participation, or DEA license is tied to Obamacare participation. As more docs opt out, it's coming. Can't have the FSA underserved, you know. That'd be discriminatory. |
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Posted: 8/5/2015 7:57:37 AM EDT
[#25]
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Just wait until your state license is tied to Medicaid participation, or DEA license is tied to Obamacare participation. As more docs opt out, it's coming. Can't have the FSA underserved, you know. That'd be discriminatory. That is EXACTLY what's going to happen... or they'll extend EMTALA to clinics and offices. You will literally NOT be able to turn people away with Medicaid/self-pay, and still practice medicine. Wait until they start auditing your schedule, and show up with investigators, asking to see your appointments, all to ensure you're not selectively scheduling patients whose insurances *actually reimburse enough* to cover your costs. They'd have us all working for free if they thought they could swing it. |
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Posted: 8/5/2015 9:55:18 AM EDT
[#26]
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Snip... If you think most NPs are better than a doc for a sick group of patients (particularly the very sick), you're f*cking delusional. You can become an NP with only six years of training (BSN + two years). That doesn't exactly compare favorably to a physicans minimum of eleven years. Sorry... I get that your wife is one, and you're proud/fully-invested in her worldview, but get back to me when they do a dozen years of training before being allowed to run their own show. And I'm a supporter of NPs. We employ multiple extenders, and they're fantastic... but they also know their limitations. That latter point is the MOST important trait for an extender to have; knowing when to call for help. For much of what I see in the ER (the run-of-the-mill CHF, chest pains, basic fractures, etc) they do just as good a job as I do... but for that 10% of patients that are really sick/complicated/unstable, they need me. Interesting tidbit....there has been a considerable increase in Malpractice cases...against NPs and PAs...lately. The above agrees with what I've seen...the NPs and PAs on the hospitalist staff that I deal with on a regular basis are great....but the MD/DO hospitalists get the worst cases in the local hospital. Because of that, they're going to get the worst outcomes...just because they deal with patients that are a good deal 'sicker' than the ones the PAs do. |
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Posted: 8/5/2015 10:21:15 AM EDT
[#27]
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Snip.... I work on the insurance side of healthcare financing and ICD10 makes me want to shoot myself. what a fucking mess. A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... |
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Posted: 8/5/2015 12:25:29 PM EDT
[#28]
Twenty-six months to go for me
Not sure I can last |
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Posted: 8/5/2015 12:30:38 PM EDT
[#29]
Quote HistoryQuoted: A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... Quote HistoryQuoted: Quoted: Snip.... I work on the insurance side of healthcare financing and ICD10 makes me want to shoot myself. what a fucking mess. A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... |
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Posted: 8/5/2015 1:05:07 PM EDT
[#30]
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That is EXACTLY what's going to happen... or they'll extend EMTALA to clinics and offices. You will literally NOT be able to turn people away with Medicaid/self-pay, and still practice medicine. Wait until they start auditing your schedule, and show up with investigators, asking to see your appointments, all to ensure you're not selectively scheduling patients whose insurances *actually reimburse enough* to cover your costs. They'd have us all working for free if they thought they could swing it. Quote HistoryQuoted:
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Just wait until your state license is tied to Medicaid participation, or DEA license is tied to Obamacare participation. As more docs opt out, it's coming. Can't have the FSA underserved, you know. That'd be discriminatory. That is EXACTLY what's going to happen... or they'll extend EMTALA to clinics and offices. You will literally NOT be able to turn people away with Medicaid/self-pay, and still practice medicine. Wait until they start auditing your schedule, and show up with investigators, asking to see your appointments, all to ensure you're not selectively scheduling patients whose insurances *actually reimburse enough* to cover your costs. They'd have us all working for free if they thought they could swing it. That is exactly where it is headed. Only they won't make you work for "free" it will pay just enough to break even after you make what they consider a fair profit for the year. I never thought I would see the return of slavery in America, but here it is, just a couple of steps away. At some point there will be more foreign trained physicians working here than American doctors. I will bet you $100 bill and lunch that a lot of those foreign physicians won't exactly be here legally. |
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Posted: 8/5/2015 1:07:07 PM EDT
[#31]
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So when the wage paid to a group of people goes down, fewer people go into that profession? My God, it's almost like there is some kind of economic law at work here.  The hand. It's invisible. |
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Posted: 8/5/2015 1:21:44 PM EDT
[#32]
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If you think most NPs are better than a doc for a sick group of patients (particularly the very sick), you're f*cking delusional. You can become an NP with only six years of training (BSN + two years). That doesn't exactly compare favorably to a physicans minimum of eleven years. So... with the increase in six year medical programs or 3+3 programs and the new DNP programs are they meeting in the middle? |
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Posted: 8/5/2015 4:41:19 PM EDT
[#33]
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Y'all need to do what lawyers do. Stop billing by procedure and start billing for time. Bill for all your time preparing the records. When they start cutting the bill start inflating your rate to cover the cut. Quote HistoryQuoted:
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Snip.... I work on the insurance side of healthcare financing and ICD10 makes me want to shoot myself. what a fucking mess. A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... If you bill on time, you will go out of business. We can bill on time as long as more than 50% of the time is spent in "counseling and coordination of care." Medicare pays $133.57 for a level 5 (the highest complexity) return patient appointment. I would have to spend 40 minutes. That works out to $200 per hour. Until you take in to account the documentation that is required. It will probably take me about 10 minutes to dictate your note and do all of your prescriptions. That 10 minutes can't be counted in the 40 minutes. The 40 minutes is "face to face." I guess I could do my documenting in the room and count that as face to face, but patients don't like doctors who document in the room. So now we are at 50 minutes for that $133.57. It works out to about $165 per hour. Sounds pretty good until you take into account my overhead and 5 employees. This is all based on Medicare rates. Not that doctors like Medicare rates, but they are used as the standard that private insurances pay off of. If Medicare goes down, so do all your private carriers. Some go as far to give you the actual percentage they pay over Medicare. Medicaid isn't worth even talking about. |
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Posted: 8/5/2015 4:48:14 PM EDT
[#34]
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.................... Nope... You don't have to take that insurance. The patient can pay out of pocket and you can help them file with their insurance to get reimbursed.....you're not abandoning the patient, just not taking that insurance any more. Alternatively, you don't have to take new patients with that insurance. Yes, we're about do stop taking new Medicaid patients here in our practice for a long list of issues...low reimbursement, chronic no shows, etc. etc. I was quite surprised last year to see a banner on my Docinnabox that said they would be accepting Medicaid patients. Should have asked my GP about it last visit when he mentioned BC/BS was getting harder to work with. |
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Posted: 8/5/2015 6:56:36 PM EDT
[#35]
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A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... Quote HistoryQuoted:
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Snip.... I work on the insurance side of healthcare financing and ICD10 makes me want to shoot myself. what a fucking mess. A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... just think of all the great analysis we'll be able to do once we can identify claims as: V97.33XD: Sucked into jet engine, subsequent encounter. W51.XXXA: Accidental striking against or bumped into by another person, sequela. V00.01XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter. Y93.D: Activities involved arts and handcrafts. Z99.89: Dependence on enabling machines and devices, not elsewhere classified. Y92.146: Swimming-pool of prison as the place of occurrence of the external cause. S10.87XA: Other superficial bite of other specified part of neck, initial encounter. W61.62XD: Struck by duck, subsequent encounter. W55.41XA: Bitten by pig, initial encounter?. W61.62XD: Struck by duck, subsequent encounter. Z63.1: Problems in relationship with in-laws. W220.2XD: Walked into lamppost, subsequent encounter. V91.07XD: Burn due to water-skis on fire, subsequent encounter?. W55.29XA: Other contact with cow, subsequent encounter. W22.02XD: V95.43XS: Spacecraft collision injuring occupant, sequela. W61.12XA: Struck by macaw, initial encounter. ? R46.1: Bizarre personal appearance. |
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Posted: 8/5/2015 7:01:53 PM EDT
[#36]
Bend over....{no coughing necessary but you can grunt if you like}...for Single Payer!
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Posted: 8/5/2015 7:07:39 PM EDT
[#37]
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Hillary makes far more per-hour... For talking. At least he's helping people rather than selling influence. Restrain your class-warfare, will you? Sheesh. Quote HistoryQuoted:
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It's strange, I was just offered a Locum position at stupid money rates, something on the order of $900.00 and hour. Granted my specialty is pretty specific, but I simply can't see a hospital paying me that kind of money. $900 an hour. No wonder this country is fucked. Hillary makes far more per-hour... For talking. At least he's helping people rather than selling influence. Restrain your class-warfare, will you? Sheesh. So, now GD is all for gov meddling in a system to the point it costs $900 an hour for someone's services? Noted. |
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Posted: 8/5/2015 7:12:21 PM EDT
[#38]
Between litigation and regulation medicine as a career for a doctor is over.
Stupid Americans want the best medicines, the best diagnostic tests, the best surgeries, with immediate access and they want to pay nothing for this and still want to be able to sue at the drop of a hat for a million dollars while taking no responsibility and accountability for themselves. This will not work and it will implode and they will end up with crappy care from doctors "educated in sub-Saharan Africa with long wait times. |
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Posted: 8/5/2015 7:15:54 PM EDT
[#39]
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Basic economics are being ignored here medical cost is high because of a lack of supply. We need new med schools and more residency slots. Guess who limiting the residency slots......Uncle fed More schools have opened but not enough. Why put people through 4 years of school when there aren't residency slots for them. There are plenty of people who are capable of and want to be doctors that do other things because they had a 3.7 instead of a 3.8 gpa.
If the gov really wanted to reduce costs and avoid a shortage they should lift the cap on residency slots, instead we got the ACA. Only the gov could think a 2500 page law wold fix costs by reducing the supply Incorrect. We need more GPs and less specialists. But GPs get paid nothing. And we need to get rid of this over regulation! We just had our DOH visit for recert. My time to clean and reset a vent went from 10 minutes to 30 to 40 minutes. Arterial line placement time went from around 10 minutes to over 30. We are literally spending a quarter of the shift doing bullshit that should take less then an hour. |
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Posted: 8/5/2015 7:19:34 PM EDT
[#40]
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Between litigation and regulation medicine as a career for a doctor is over. Stupid Americans want the best medicines, the best diagnostic tests, the best surgeries, with immediate access and they want to pay nothing for this and still want to be able to sue at the drop of a hat for a million dollars while taking no responsibility and accountability for themselves. This will not work and it will implode and they will end up with crappy care from doctors "educated in sub-Saharan Africa with long wait times. Getting ready for union nurses and "dr nick" imported from Haiti. good times. Better go eat some celery and go for a walk. |
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Posted: 8/5/2015 7:33:51 PM EDT
[#41]
Quote Historylol +1 |
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Posted: 8/5/2015 8:24:16 PM EDT
[#42]
Quote HistoryQuoted: Between litigation and regulation medicine as a career for a doctor is over. Stupid Americans want the best medicines, the best diagnostic tests, the best surgeries, with immediate access and they want to pay nothing for this and still want to be able to sue at the drop of a hat for a million dollars while taking no responsibility and accountability for themselves. This will not work and it will implode and they will end up with crappy care from doctors "educated in sub-Saharan Africa with long wait times. |
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Posted: 8/5/2015 8:32:55 PM EDT
[#43]
Aloha, Mark |
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Posted: 8/5/2015 8:44:22 PM EDT
[#44]
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just think of all the great analysis we'll be able to do once we can identify claims as: V97.33XD: Sucked into jet engine, subsequent encounter. W51.XXXA: Accidental striking against or bumped into by another person, sequela. V00.01XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter. Y93.D: Activities involved arts and handcrafts. Z99.89: Dependence on enabling machines and devices, not elsewhere classified. Y92.146: Swimming-pool of prison as the place of occurrence of the external cause. S10.87XA: Other superficial bite of other specified part of neck, initial encounter. W61.62XD: Struck by duck, subsequent encounter. W55.41XA: Bitten by pig, initial encounter?. W61.62XD: Struck by duck, subsequent encounter. Z63.1: Problems in relationship with in-laws. W220.2XD: Walked into lamppost, subsequent encounter. V91.07XD: Burn due to water-skis on fire, subsequent encounter?. W55.29XA: Other contact with cow, subsequent encounter. W22.02XD: V95.43XS: Spacecraft collision injuring occupant, sequela. W61.12XA: Struck by macaw, initial encounter. ? R46.1: Bizarre personal appearance. Quote HistoryQuoted:
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Snip.... I work on the insurance side of healthcare financing and ICD10 makes me want to shoot myself. what a fucking mess. A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... just think of all the great analysis we'll be able to do once we can identify claims as: V97.33XD: Sucked into jet engine, subsequent encounter. W51.XXXA: Accidental striking against or bumped into by another person, sequela. V00.01XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter. Y93.D: Activities involved arts and handcrafts. Z99.89: Dependence on enabling machines and devices, not elsewhere classified. Y92.146: Swimming-pool of prison as the place of occurrence of the external cause. S10.87XA: Other superficial bite of other specified part of neck, initial encounter. W61.62XD: Struck by duck, subsequent encounter. W55.41XA: Bitten by pig, initial encounter?. W61.62XD: Struck by duck, subsequent encounter. Z63.1: Problems in relationship with in-laws. W220.2XD: Walked into lamppost, subsequent encounter. V91.07XD: Burn due to water-skis on fire, subsequent encounter?. W55.29XA: Other contact with cow, subsequent encounter. W22.02XD: V95.43XS: Spacecraft collision injuring occupant, sequela. W61.12XA: Struck by macaw, initial encounter. ? R46.1: Bizarre personal appearance. Those look familiar. 
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Posted: 8/5/2015 9:17:19 PM EDT
[#45]
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Those look familiar. Quote HistoryQuoted:
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Snip.... I work on the insurance side of healthcare financing and ICD10 makes me want to shoot myself. what a fucking mess. A brief FAQ for those reading that aren't familiar with what ICD means... It's 'International Classification of Disease'... Right now, we use ICD-9. Being a Foot Doctor, I'll code: 703.0 (ingrown nail). 728.71 (plantar fasciitis) 110.1 (Fungal/Dystrophic Nails). 250.71 (Insulin Dependant Diabetic with Peripheral Vascular Disease). 250.70 (Non-Insulin Dependant Diabetic, etc.) So it's a 5 digit (max) code...3 places before the decimal and one or two after. ICD-10 will have up to 7 digits. The first few will relate to the particular 'region' of the issue. The next will indicate the problem, the severity and the side. Finally, there will be a code for the initial visit, follow up, etc. So my ingrown nail will be: L60.0xxx Plantar Fasciitis will be: M72.2xxx Of course, those Xs May need to be populated with additional codes the severity, side, and if it's an initial visit or follow up, or a sequellae of a prior problem... You'll notice...that almost NONE of the crap from ICD-10 has anything to do with the actual treatment by the Doctor...and everything to do with keeping records on what was done to the patient...for the insurance companies. No, ICD-10 is going to be a nightmare...a lot of the codes don't match up directly to old ICD-9 stuff, then figuring the add on codes, etc makes it much, much worse..... just think of all the great analysis we'll be able to do once we can identify claims as: V97.33XD: Sucked into jet engine, subsequent encounter. W51.XXXA: Accidental striking against or bumped into by another person, sequela. V00.01XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter. Y93.D: Activities involved arts and handcrafts. Z99.89: Dependence on enabling machines and devices, not elsewhere classified. Y92.146: Swimming-pool of prison as the place of occurrence of the external cause. S10.87XA: Other superficial bite of other specified part of neck, initial encounter. W61.62XD: Struck by duck, subsequent encounter. W55.41XA: Bitten by pig, initial encounter?. W61.62XD: Struck by duck, subsequent encounter. Z63.1: Problems in relationship with in-laws. W220.2XD: Walked into lamppost, subsequent encounter. V91.07XD: Burn due to water-skis on fire, subsequent encounter?. W55.29XA: Other contact with cow, subsequent encounter. W22.02XD: V95.43XS: Spacecraft collision injuring occupant, sequela. W61.12XA: Struck by macaw, initial encounter. ? R46.1: Bizarre personal appearance. Those look familiar. First hit on Google for "absurd icd10". Posted Via AR15.Com Mobile |
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Posted: 8/5/2015 9:53:55 PM EDT
[#46]
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I think hospitals are going to chase the bottom line and replace physicians wherever possible with mid level providers. Hospitalists at all of the private hospitals here primarily admit and optimize home meds, maybe order an RT protocol, sliding scale insulin. More and more teams here are having NP's round and the physicians are becoming more of a peripheral accessory. It's a lot different practice than the ICU or an academic hospital practice. I don't think the hospitalist job is bad per se but as more private groups are folded into an employee position they're going to lose leverage and the hospitals are going to decrease costs. Quote HistoryQuoted:
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It's going to result in a big crunch to have nurse practioners and physician assistants take over the primary care fields, and some specialty fields, at a cost of poorer quality of care. Family medicine, internal medicine, OB/GYN, emergency medicine, and anesthesia are being taken over by nurses. In this regard Obamacare advocates can claim they have maintained or even increased access for patients, although their outcome measures are almost intentionally designed not to evaluate the resultant effect of poor quality care. I had a friend who was very competitive in med school, in some regards more so than myself, and he matched into internal medicine with no interest in pursuing a subspecialty. He just took a hospitalitist job and I can't see that being a viable long term employment strategy. To his credit he is out of training while I have a few years left, on the other hand I have what I believe is better job security and certainly a better pay scale. Just curious why you think that? They do shift work so it's predictable and get a lot of time off. There are even hospitalists that are nocturnists ie. only work nights so he could likely only work day shifts. I'm a specialist and I would have no interest in that kind of work though. I think hospitals are going to chase the bottom line and replace physicians wherever possible with mid level providers. Hospitalists at all of the private hospitals here primarily admit and optimize home meds, maybe order an RT protocol, sliding scale insulin. More and more teams here are having NP's round and the physicians are becoming more of a peripheral accessory. It's a lot different practice than the ICU or an academic hospital practice. I don't think the hospitalist job is bad per se but as more private groups are folded into an employee position they're going to lose leverage and the hospitals are going to decrease costs. Got it. I'm a specialist and I've noticed in the last 1 to 1 1/2 years that the hospitals are bringing in a lot more ARNP's and I'm getting more calls from them. Not that I have delusions of having any significant power, but you're right that hospitalists are more "disposable" for lack of a better word. They do have the advantage of not needing to build up a practice as they do shift work. Posted Via AR15.Com Mobile |
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Posted: 8/5/2015 9:58:54 PM EDT
[#47]
its really time to doctor ourselves huh?
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Posted: 8/5/2015 9:59:21 PM EDT
[#48]
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Those boats are a floating infection pool now and they are full of "healthy" people. Quote HistoryQuoted:
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Why... it's almost exactly as I predicted it would be. It's almost like I do this for a living. Oh... wait... I do.
When you make your move to the Caribbean, please post it here. I'd like to apply with your new practice. Honestly, I am looking forward to cruise ships converting to floating hospitals, and elective surgery centers. Posted Via AR15.Com Mobile Those boats are a floating infection pool now and they are full of "healthy" people. Really not much different than a hospital then. Posted Via AR15.Com Mobile |
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Posted: 8/5/2015 10:55:32 PM EDT
[#49]
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Accountable Care Organizations....essentially rebadged HMOs.... Quote HistoryQuoted:
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Some insight from a neighbor who's a hospital administrator: Increasingly, hospitals are being assigned groups of people (from the government health exchange networks I expect) that they are responsible for within the local community. It's a sort of risk pool of healthy people, average people, unhealthy people, and really unhealthy people. Depending on how each person is classified, the hospital is given a sum of money each month. For a healthy person in the risk pool, the hospital might receive $200/month while the hospital might receive $1100/month for a really unhealthy person like an obese diabetic alcoholic or such. Then the hospital is completely responsible for providing care to all those in their pool of assigned patients. If it costs the hospital less to treat a patient than the money the hospital receives each month, the hospital makes money. If it costs more to treat someone than the money the hospital receives, the hospital loses money. It's up to the hospital to find creative ways to save on the cost of treating patients. My first question upon hearing about this was, "Doesn't this incentivize the hospital to withhold treatment?" The reply the hospital administrator gave was, "Well, yes. But the hospital is also supposed to be compensated based on patient satisfaction. So that is supposed to balance the incentives." Yeah.
The administrator also commented that, "Americans are going to have to give up on the expectation of getting treatment just because they can afford it." Healthcare is going to be rationed. Accountable Care Organizations....essentially rebadged HMOs.... I'll add that the portion of reimbursement based on patient satisfaction is supposed to be relatively small, ? 10%, so it's still in the hospital's best interest to withhold as much care find as many cost-saving measures as possible. One of my partners sees about 50% more patients than I do, but he orders 7 times more tests. Guess who the hospital/group practice will want to get rid of given the new reimbursement algorithm? As I've become more experienced, I order fewer and fewer tests. This will serve me and my patients well if this new model should come to pass. Posted Via AR15.Com Mobile |
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Posted: 8/5/2015 11:03:29 PM EDT
[#50]
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YEAH, and they're awesome.
Affirmative action for one. Others so fucking stupid, lazy and entitled. One of them (not med student or intern but a resident--hung blood on a patient without checking it. 2 units. ) Another was asked if he had removed a certain tube from the patient's mouth---he didn't get out of chair "yes". Surgeon proceeded---lo and behold he had not removed the tube. Surgeon stapled across it.
I usually rant on the rotten nurses but the docs are going downhill fast. Quote HistoryQuoted:
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That explains why all the premed and medical school classes are completely empty. lol They don't understand what they're getting themselves into. They only know medicine from watching House and reruns of ER. I've talked multiple people into avoiding medical school. If they absolutely want to do healthcare as a profession, I advise them to become a PA or ARNP. Well despite your efforts all the medical schools in the U.S. once again full with new med students. As far as NPs go, they are the future of primary healthcare. The days of making big bucks as a GP is gone for MDs. They have priced themselves out of the market. This has little to do with Ocare and ever thing to do with cost to benefit to cost ratio.
Affirmative action for one. Others so fucking stupid, lazy and entitled. One of them (not med student or intern but a resident--hung blood on a patient without checking it. 2 units. ) Another was asked if he had removed a certain tube from the patient's mouth---he didn't get out of chair "yes". Surgeon proceeded---lo and behold he had not removed the tube. Surgeon stapled across it.
I usually rant on the rotten nurses but the docs are going downhill fast. +1 They're certainly nothing to write home about. There has been a fundamental transformation in the nature of medical training. As one doc put it, "It used to be iron men and wooden ships. Now it's iron ships and wooden men." Their work ethic is in the toilet. Posted Via AR15.Com Mobile |
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