Comments on: Inconvenient truths about our health care system

By: NN

NN — Tue, 29 Sep 2009 19:10:09 +0000

If both doctors & patients are unhappy about health care system, then, who is actually happy? Insurance companies? Govt?

By: pp

pp — Thu, 24 Sep 2009 06:25:36 +0000

Convenient Truths

I practice in the suburbs of New York city and 50% of the insurances pay $40 or less. United Healthcare just handed me new rates saying they will be paying me $35 for a 99213.

The pay rates have nothing to do with being rural or in a metroplitan area, it has to do with clout. As a singe physician I have none.

By: Convenient Truths

Convenient Truths — Wed, 23 Sep 2009 04:25:23 +0000

I live in a suburb of a large metropolitan city. The clinic I spoke about is part of a big medical center which probably has good negotiating power when it comes to contracts with insurance companies. I was floored when I saw how much they charged for a visit that was a waste of time-I had to see a doctor anyway. Of course, the specialist charged me a lot less.

Perhaps practicing in a rural setting is affecting you bottom line.

By: Rural PCP

Rural PCP — Tue, 22 Sep 2009 22:57:27 +0000

I want to know where a primary care NP gets $300 for an office visit. I get $75 if I am lucky. Sign me up. The way the current regulations are written though I cannot offer to see a patient for a reduced amount for cash pay if they don’t have insurance and desire to pay as I would violate medicaire/medicaide regulations. The primary care physician cannot legally set any of their costs. I like the Robin Hood concept discussed above. True so true unfortunately. Also unfortunately as primary care we are forced to see more patients in less time to keep up with the overhead created by more regulations as we have had to hire roughly 30% of our work force in our rural hospital and clinic to just deal with paperwork and staying compliant with regulations. More patients in less time = increased quantity of care = decreased quality of care in my opinion.

By: Convenient Truth

Convenient Truth — Sat, 19 Sep 2009 16:11:28 +0000

“referring to patients (the public), not MDs.”

Why does the patient have all the responsiblilty to make sure the doctor get paid what he wants? I don’t understand why this is patient issue only. Insurance company/government pricing makes it difficult for patients to make sound financial decisions.

By: Nuclear Fire

Nuclear Fire — Sat, 19 Sep 2009 12:36:43 +0000

I really enjoy seeing patients with limited funds (well, everyone has limited funds but those paying cash (read working poor, not rich) or using HSAs are much more cognizant of that fact) because I actually get to have an intelligent conversation about possible diagnoses, the rarity and unlikelihood of certain diagnosis and different options. Then you get involved patients who may says things like:
1. You know, I know it’s highly unlikely and that we don’t need to diagnose it early but I’m just not going to be able to sleep worrying about if I have it or not so I’m willing to pay for an MRI.
or
2. Well, that’s a lot of money. If it’s super rare, then I’d rather just wait and see if it doesn’t go away and call you if things change because at least I know I don’t have something bad I have to fix now.

In contrast, my conversations with those covered by our states charity plan:
3. I want EVERYTHING done. (Uh, an MRI isn’t indicated.) But I want EVERYTHING DONE. (I already know the diagnosis and told you what it is, more testing isn’t indicated.) You’re a terrible doctor because you don’t order all the tests I’ve read about on the internet (Seriously was told that when their ANA was negative but they wanted the patterns of the ANA because they read about them on the internet.)

God bless informed, rational, involved patients.

By: Martin Young

Martin Young — Sat, 19 Sep 2009 07:25:37 +0000

And it goes completely against the grain for a good doctor to refuse care based on inability to pay.

By: Martin Young

Martin Young — Sat, 19 Sep 2009 07:23:04 +0000

Cash only is fine in principle, but many of my patients simply don’t have the cash on hand. Credit is not a sensible option. In many ways I am forced to practice Robin Hood medicine, charging those who can afford to pay more to subsidise those who can’t! And how do you make that distinction? The patient’s car, watch, cellphone or residential address? Looks alone are very misleading.

By: dearlizzie

dearlizzie — Sat, 19 Sep 2009 06:31:02 +0000

Dr. Reece has not thought through some of his statements nor examined the facts in all cases. A recent study looking at tests ordered by doctors before and after they purchased scans or other machinery shows that far more tests are ordered when a doctor or practice own the testing machines. The Mayo Clinic put all its docs on salary and once they were not chasing fees for services, docs ordered far fewer tests according to the Clinic. Doctors may be entirely unconscious of this but it seems to be a reality.The actual stats on medical malpractice suites show torts are not a driver of health care costs. Tort reform is a red herring asserts Connecticut law professor and insurance expert Tom Baker. Most suits are meritorious and all costs, from litigation expenses to pay outs & alleged premium increases only total less than 1% of all health care costs.

By: Evinx

Evinx — Sat, 19 Sep 2009 05:34:16 +0000

Convenient Truths
This sentence “We can solve so much if we control more of the bucks” was referring to patients (the public), not MDs.