Comments on: Defensive medicine in the US? Shocking! http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html medical blog Sun, 22 Nov 2009 22:50:49 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79310 Anonymous Tue, 21 Aug 2007 01:58:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79310 Regarding fee for service:<br/><br/>That tradition goes way back in medicine when the physician, if he lived off his profession, (for many it was the vocation of the independently wealthy) lived by collecting substantial fees from his few well-heeled patients, moderate fees from his middle class patients, and no fees or nominal fees from his poor patients who may actually make up the bulk of his practice. The substantial fees collected from his well off patients were as much patronage as fees and were seen as something of an obligation by that class in supporting his work. I think you can see how and hourly system would not have fit in their at all.<br/><br/>I have always been somewhat suspicious that the perpetuation of the system into the 20th century was something of a ploy to prevent the newly arrived third party payors from being able to put a ceiling on physicians net income. Now of course they have that control but with them in the enviable position of paying piece work rates to labor which they substantially control--a position which is so rife with abuse by payors that it was outlawed in industrial sectors over a hundred years ago.<br/><br/>It is clear now that physicians need to move to hourly rate just as do other professions, as it makes for true price transparency, requires less intrustion for third parties to monitor for fraud, and makes it easier to defend the price-value relationship of the work by comparison to the fees of other professions with substantially less education, stress, practice expense, and responsibility.<br/><br/>I had a repairman to my house a couple of weeks ago who charged more for an hours service than any third party will pay me when FFS fees are translated.<br/><br/>The problem with FFS is that it rewards fast sloppy work. Regarding fee for service:

That tradition goes way back in medicine when the physician, if he lived off his profession, (for many it was the vocation of the independently wealthy) lived by collecting substantial fees from his few well-heeled patients, moderate fees from his middle class patients, and no fees or nominal fees from his poor patients who may actually make up the bulk of his practice. The substantial fees collected from his well off patients were as much patronage as fees and were seen as something of an obligation by that class in supporting his work. I think you can see how and hourly system would not have fit in their at all.

I have always been somewhat suspicious that the perpetuation of the system into the 20th century was something of a ploy to prevent the newly arrived third party payors from being able to put a ceiling on physicians net income. Now of course they have that control but with them in the enviable position of paying piece work rates to labor which they substantially control–a position which is so rife with abuse by payors that it was outlawed in industrial sectors over a hundred years ago.

It is clear now that physicians need to move to hourly rate just as do other professions, as it makes for true price transparency, requires less intrustion for third parties to monitor for fraud, and makes it easier to defend the price-value relationship of the work by comparison to the fees of other professions with substantially less education, stress, practice expense, and responsibility.

I had a repairman to my house a couple of weeks ago who charged more for an hours service than any third party will pay me when FFS fees are translated.

The problem with FFS is that it rewards fast sloppy work.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79159 Anonymous Fri, 17 Aug 2007 13:25:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79159 It's not about bad healthcare? Really? I guess all those insurance companies are paying settlements on GOOD healthcare where nothing bad happened. Because doctors never make mistakes, eh Greg? And those mistakes never cost anyone any money, do they? It’s not about bad healthcare? Really? I guess all those insurance companies are paying settlements on GOOD healthcare where nothing bad happened. Because doctors never make mistakes, eh Greg? And those mistakes never cost anyone any money, do they?

]]> By: Greg P http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79144 Greg P Fri, 17 Aug 2007 01:36:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79144 Suing after an accident, suing health care deliverers is a lottery that is legal in all of the US. It's not about bad health care, it's just people trying to make a buck out of an "unfortunate/fortunate" event. Suing after an accident, suing health care deliverers is a lottery that is legal in all of the US. It’s not about bad health care, it’s just people trying to make a buck out of an “unfortunate/fortunate” event.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79122 Anonymous Thu, 16 Aug 2007 18:33:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79122 Then do it. If there are truly 47 million uninsured Americans out there, then you've got a lot of potential clients/patients. Market to them. Then do it. If there are truly 47 million uninsured Americans out there, then you’ve got a lot of potential clients/patients. Market to them.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79119 Anonymous Thu, 16 Aug 2007 17:20:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79119 Geez... just because doctors 50 years ago set up the system doesn't mean that we want the same system. I want to be able to bill in 15 minute increments rounded up just like my lawyer does. Also, whenever I research a case or make a phone call pertaining to a case I want to be able to bill for the time. Geez… just because doctors 50 years ago set up the system doesn’t mean that we want the same system. I want to be able to bill in 15 minute increments rounded up just like my lawyer does. Also, whenever I research a case or make a phone call pertaining to a case I want to be able to bill for the time.

]]> By: ERMurse http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79117 ERMurse Thu, 16 Aug 2007 16:44:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79117 The whole c-spine precautions argument is interesting especially since there is no evidence that strapping someone to a backboard or leaving them on a backboard during their ER stay until x-ray/ct clears the spine reduces disability from c-spine injuries. Some recent evidence suggest it may worsen outcomes. I personally think that a backboard is good for picking someone up off the ground but once on a stretcher serves no purpose except to create problems like pressure sores, agitation, airway issues, and others. Patients can be in adequate c-spine precautions by remaining supine or low fowlers with a collar. The whole c-spine precautions argument is interesting especially since there is no evidence that strapping someone to a backboard or leaving them on a backboard during their ER stay until x-ray/ct clears the spine reduces disability from c-spine injuries. Some recent evidence suggest it may worsen outcomes. I personally think that a backboard is good for picking someone up off the ground but once on a stretcher serves no purpose except to create problems like pressure sores, agitation, airway issues, and others. Patients can be in adequate c-spine precautions by remaining supine or low fowlers with a collar.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79115 Anonymous Thu, 16 Aug 2007 16:04:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79115 Actually, Kevin, physicians did make the rules. It takes someone agreeing to accept the nature of the payment scheme to form the bargain. And physicians have, for some 40 years now, agreed to accept that scheme. <br/><br/>Until you take some responsibility for your actions, and start refusing to sign agreements that don't pay you by the hour, what's going to change? Actually, Kevin, physicians did make the rules. It takes someone agreeing to accept the nature of the payment scheme to form the bargain. And physicians have, for some 40 years now, agreed to accept that scheme.

Until you take some responsibility for your actions, and start refusing to sign agreements that don’t pay you by the hour, what’s going to change?

]]> By: Kevin http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79108 Kevin Thu, 16 Aug 2007 14:42:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79108 I've blogged against a fee-for-service reimbursement system numerous times here. Allowing physicians to bill by hour makes more sense to me.<br/><br/>We didn't make the rules, we just play by them. It's simply making the most of a bad system. <br/><br/>So, instead of blaming the players, blame the game instead.<br/><br/>Thanks,<br/>Kevin I’ve blogged against a fee-for-service reimbursement system numerous times here. Allowing physicians to bill by hour makes more sense to me.

We didn’t make the rules, we just play by them. It’s simply making the most of a bad system.

So, instead of blaming the players, blame the game instead.

Thanks,
Kevin

]]> By: Anonymous http://www.kevinmd.com/blog/2007/08/defensive-medicine-in-us-shocking.html/comment-page-1#comment-79107 Anonymous Thu, 16 Aug 2007 14:36:00 +0000 http://clients.emmense.com/kevinmd/2007/08/defensive-medicine-in-the-us-shocking.html#comment-79107 Probably when we started paying doctors by the procedure, rather than their time or the quality of their care.<br/><br/>How long ago did you guys cut that deal, Kevin? Probably when we started paying doctors by the procedure, rather than their time or the quality of their care.

How long ago did you guys cut that deal, Kevin?

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