Slashdot Mirror
How Outdated Data Distorts Doctors' Pay
Hugh Pickens DOT Com writes "Peter Whoriskey and Dan Keating report at the Washington Post that Medicare annually pays $69.6 billion for physician services according to an arcane and little-known price list, known as the Relative Value Update over which doctors themselves exercise considerable and less-than-totally-transparent influence. A 31-member committee of the American Medical Association (AMA) recommends what Medicare should pay for some 10,000 procedures — with the fees based in part on how long it takes to complete each one. But this time-and-motion study often fails to take full account of changing technology and other factors affecting physician productivity, so anomalies result. For example, if the AMA time estimates are correct, then 41 percent of gastroenterologists were typically performing 12 hours or more of procedures in a day, which is longer than the typical outpatient surgery center is open and and one gastroenterologist in the Post story would have to work 26 hours, according to the committee time estimates, to accomplish what he gets done in a typical workday. Here's how it works: Medicare pays for a 15-minute colonoscopy as if it took 75 minutes resulting in a median salary for a gastroenterologist of $481,000. It is possible that in 1992, critics allow, when the price list was first developed, a colonoscopy actually took something close to 75 minute when doctors had to hunch over an eyepiece similar to that of a microscope for a look. But technology has advanced and now the images are processed and displayed on a large screen in high-definition video. Responding to criticism that the nation's method of valuing medical procedures misprices payments, a bipartisan group of legislators has drafted a bill that would reshape the way the nation pays doctors. The bill would require Medicare officials to collect data such as how much time doctors spend doing procedures and reducing the doctor payment for overvalued services. 'What started as an advisory group has taken on a life of its own,' says Tom Scully, who was Medicare chief during the George W. Bush Administration. 'The idea that $100 billion in federal spending is based on fixed prices that go through an industry trade association in a process that is not open to the public is pretty wild.'"
Praise legacy data
Sad, racist H8ah
Or sweep it from chin
For cleanshaven win!
Burma Shave
Get thee glass eyes, and, like a scurvy politician, seem to see things thou dost not.--King Lear
Speak for yourself, I find this interesting.
On the other hand, if you _really_ would like to see other stories on /., feel free to submit stories yourself. After all, that is how /. works.
Thanks, /.
The other 99% of
It is a joke. The story had been posted to Slashdot three times already.
So, it appears the article only talks about the time spent by the physician. I'm curious if the costs of the tools/technologies of these procedures have gone up, and how the doctors get paid for those (potentially) increased costs?
Impossible to fix it. Private business will loot the treasury until there's nothing left. Everyone's paid off. The fix is in.
Watch the Bumpus Hounds scene from A Christmas Story when they eat the turkey. That's America's future.
Americans are too fucking stupid to fix it.
So we no longer want to reward efficiency? Since these doctors spent the time and money to get equipment that's less invasive and works better/faster/cheaper, we should cut their pay.
A torn meniscus repair takes 5 minutes and costs $9000. Wish I made that kind of money. OK. So the cost was broken down into 3 ~$2500 procedures and the balance was assorted stuff like anaesthesia and bandaids. But still, 5 minutes of time for $7500 in doctor pay of which the assisting nurse will $3.50.
"Cut Medicare spending? Why do they want old people to die? Our seniors have earned this?"
Just wait for it.
It's only tens of billions of other peoples' dollars a year. Why bother checking up vs. what insurance companies pay, who have incentive to not be wasteful?
(-1: Post disagrees with my already-settled worldview) is not a valid mod option.
Just accept that your attempt at humour failed.
Sorry no information in this comment I'm just throwing out there that in my opinion since insurance companies are increasingly becoming the payors for services rather than individuals it seems stories like this are becoming more prevalent. I mean, and I stand to be corrected it seems that the medicare system now has a "watchdog/whistleblower" vis a vis the insurance companies. It appears to me insurance companies don't like to pay the costs it used to be OK for the average joe to mortgage their house/ruin their future for.
You know I am sick and tired of everyone blaming doctors for the cost of healthcare in the US. When in fact, doctors salaries are a miniscule portion of US healthcare, especially compared to drugs and device costs and hospital CEO pay! Doctors should be paid MORE. Yes I said it, more! What other profession do you study at least 12 years before you make a decent salary, take on at least $250k in school loans, and work 12 hour days for your entire career?
Yes doctors make good money but it's far less than other folks in the US make who are far less deserving. How about addressing the seriously disgusting salaries on wall street? Should a computer nerd working in Morgan's computer risk group really be making $500k which is FAR more than the majority of doctors? What about the asshole investment bankers making millions at Goldman figuring out new ways to screw every US citizen out of a couple of pennies. Meanwhile the doctor is someone who makes you feel better and often will save your life.
p.s. I am not a doctor. I just work with a lot of them and see how hard a life they have nowadays.
But they may want to be cautious the next time they go to a doctor; they might be quite upset at the pay cut...
"... prices that go through an industry trade association in a process that is not open to the public is pretty wild."
It's okay to question the practice of non-transparency if national security isn't involved. Invoke national security and all bets are off.
I want this at +5 _Redundant_
My car dealer does this also. My car may be physically in the shop for 4 hours, but somehow 6 hours of work is performed (by a single mechanic).
Already posted on the front page, mate:
http://it.slashdot.org/story/13/07/30/010237/students-hijack-80-million-superyacht-with-gps-spoofing
- Witticism is an epitaph on the death of a feeling
When the money comes from a Monoply box, there's no incentive for accuracy, only more money.
I want to delete my account but Slashdot doesn't allow it.
you must be new here... a misunderstood joke is ALWAYS followed by a "Whoosh" post!
The light regulation being complete price and quality transparency, with the prices for all procedures and outcome statistics easily available online. Put the prices for the 100 most common procedures on posters in large type every 200 feet in every hospital. Put a booklet in every hospital and clinic room. Even insured people frequently have a high co-pay. Think prices wouldn't drop?
Other prices would come down quickly if congress were to deregulate. Allow insurance and prescription drug purchases across state and international lines and prices would drop in a hurry.
Moreover, the whole "prescription" idea is a bit of a racket. If I want to buy a stronger zinc oxide cream for foot problems, I have to see a doctor and get a prescription. For foot cream with 5% zinc oxide. I mean, WTF? It's time to release all but the most dangerous drugs into the wild.
My 2 bitcoins.
Please do not read this sig. Thank you.
What about the opposite problem? Doctor performs a procedure in his office which includes the use of a $100 disposable device. Medicare pays him $35 for that procedure. Doctor either eats that difference, or chooses not to see Medicare patients.
This is a red herring. If they are looking to save money, look at the lawyers, insurance companies, and drug companies.
(I am not a doctor, nor do I play one on TV.)
So in order to fix under regulation, we reduce regulation.. To me that does not sound like the fix.
When you cant win, ad hominem.
15 minutes for a colonscopy? Where do they get this number? Getting informed consent can take 15 minutes just by itself (and is something the doc has to do). 15 minutes sounds like the best-case scenario (e.g. a screening colonscopy on a healthy 50 year old with no findings) and a number to sensationalize the article. What is the distribution of times that the procedure takes? Maybe 75 minutes is actually a reasonable time to expect the procedure to take on average?
That the health care system in this country is screwed up is not at issue. The article wants to point out the ludicrousness of the reimbursement mechanisms in place. Putting in a context-free and unexplained statistic only weakens its argument.
-- The Genesis project? What's that?
The way private sector insurance companies determine prices is even more fucked up, because they always end up paying more then Medicare.
Granted frequently that's because hospitals flat-out refuse any proposal to pay less then Medicare offers, but you'd think if the private sector was actually good at setting health prices they'd have found a way to do so that was better-sounding then "pay whatever the government will pay, plus 20%, because that asshole plays hardball."
While it is stated: "... technology has advanced and now the images are processed and displayed on a large screen in high-definition video.", the cost of the technology and the "overage" in cost per procedure goes hand in hand. It may now only take 15 minutes to preform what used to take 75 minutes, but if the doctors are only reimbursed for their time for the procedure, they would never be able to afford the technology which would put them back to 75 minute procedures.
This technology not only helps to produce more accurate test results, but allows more patients to be able to have these tests each day. That all comes at a cost. If a procedure is reimbursed $100 for a supposed 60 minute procedure using older technology, and that procedure now only takes 15 minutes using newer technology, More of the $100 has just been shifted from doctor salary to technology cost.
Instead of cutting the cost of the procedures, they need to find the doctors and facilities that are scamming the system, billing for procedures that aren't actually performed. (Like Columbia/HCA that Governor Rick Scott of Florida resigned from as Chief Executive in 1997 amid a controversy over the company's business and Medicare billing practices. He was not implicated, but the company ultimately admitted to fourteen felonies and agreed to pay the federal government over $600 million.)
Let me see if I understand this: A centralized, bureaucratic, government-run program is sclerotically unresponsive to the market, cost-inefficient, and ultimately impairs the ability of ...seriously?
- individuals to get the care they need
- professionals to get compensated to the degree due based on current practices, technology, understanding, etc.
- competitive forces to keep prices down.
That's unpossible. I'd ask my friend Adam Smith to comment, but I think he's banned from Slashdot.
-Styopa
Hate to burst part of your bubble, but whining about doctor pay doesn't wash.
My modest proposal: Free medical school for all.
Every year, the med school cohort is about 20,000 per year (~80K in school at any given time https://www.aamc.org/data/facts/). The total bill for this (assuming your $250K/student/year) sums to $20 billion / year. In 2011, total healthcare spending was $2.7 trillion (http://go.cms.gov/13juHDi).
This means that paying for everyone's medical school would add 0.74% to the annual healthcare bill.
No more doctor shortages, as it would only be a pittance to increase the availability of doctors relative to total spending -- All the GPs you could ask for!
Unburdened by debt, these newly minted doctors (not "socialized", merely educated for free -- like soldiers or most children) could enter the health market unburdened by crushing debt. And without your rationalization of "poor doctors learn so hard and have debt", their actual work/pay schedules could be rejiggered re: social benefit and working hours.
And comparing them to Goldman assholes? Please! Doctors actually produce some social good. Goldman, notsomuch.
However, you are naturally correct that the real cost drivers are Big Pharma and fee-for-service hospitals. Broken patent law + "evergreening" drugs siphons gigantic sums from real healthcare delivery into what are essentially ill-gotten rents supported by regulatory capture.
Fixing the catastrophically broken system at large is not likely to happen, but ensuring that enough primary care physicians enter the market is within easy reach; there are certainly more than enough idealistic and talented people to fill all of the required slots. And even such a humble speciality makes good coin. And its attractiveness would certainly increase for those on the fence... with no student debt to look forward do.
Why, when a complex system with thousands of pages of rules gets gamed because there's billions of dollars at stake, I'm sure making it even more complex with even more rules is going to fix the problem.
Right?
Huh? Did you even read my comment?
Health care has been heavily regulated for decades and costs have spiraled out of control. Obviously, regulation isn't working, and hence we should have less of it, not more. In different, the problem is overregulation.
The light regulation being complete price and quality transparency, with the prices for all procedures and outcome statistics easily available online. Put the prices for the 100 most common procedures on posters in large type every 200 feet in every hospital. Put a booklet in every hospital and clinic room. Even insured people frequently have a high co-pay. Think prices wouldn't drop?
Other prices would come down quickly if congress were to deregulate. Allow insurance and prescription drug purchases across state and international lines and prices would drop in a hurry.
Moreover, the whole "prescription" idea is a bit of a racket. If I want to buy a stronger zinc oxide cream for foot problems, I have to see a doctor and get a prescription. For foot cream with 5% zinc oxide. I mean, WTF? It's time to release all but the most dangerous drugs into the wild.
My 2 bitcoins.
The problem with insurance is not that who you can buy from is regulated it's that for-profit insurance fundamentally adds systematic inefficiency and should never be used of something like basic healthcare.
My 2 bitcoins.
Uh, that's a hundred bucks, dude.
You must be a good tipper.
Is that Medicare pays approximately 25% of those so-called rack-rates. Private insurance typically pays 30% over the Medicare pay rates.
Overcharged? Perhaps. It's all this BS, though, that we're discussing right now (and Congress is mandating) that's causing it.
Want to actually make affordable healthcare? FIX THAT FIRST.
(Hint: It doesn't get fixed by bureaucracies like this and it doesn't get fixed by doing socialized medicine.)
I am not merely a "consumer" or a "taxpayer". I am a Citizen of the State of Texas
Costs have spiraled out of control because of insurance and underregulation. Have you ever looked at a demand chart for medical usage with and without insurance? I have and it is not pretty.
When you cant win, ad hominem.
And you'd regulate the heck out of it. The more regulation you have the more costs you have. Pure and simple. Got to be a happy medium- and YOU aren't asking for that.
I am not merely a "consumer" or a "taxpayer". I am a Citizen of the State of Texas
Try a little different line there and you'd have it.
Private insurance typically pays out 30% of what Medicare pays out.
Medicare pays out 25-30% maximum in most cases with a few exceptions like powered wheelchairs for the disabled. They don't do dental. They don't do vision.
Tell me again that it's JUST the for-profit industry...
I am not merely a "consumer" or a "taxpayer". I am a Citizen of the State of Texas
Having just had my first colonoscopy just last week, I can vouch that it took the doctor much longer than the Washington Post is claiming. I spoke with him before and after the procedure. Did it take 75 mins? Maybe slightly less if you consider that he wasn't with me the entire time, and I couldn't even confirm that it was him who did the procedure, since I was knocked out. How much time should the doctor spend talking to you, and reviewing the results, even if the specific procedure was 15 minutes?
Just another day in Paradise
Each hospital needs to have an price list that is easy to find and must show the all in price for doing X it's ok to show an rage but there will be limits on how big it can be.
Also any ER care must be an fixed price for all hospital in the same area
a dentist, and even I can tell you there's more to the story here. That 75 minute colonoscopy is probably an average. No one can predict exactly how long any given procedure will take on any specific patient. If a patient has no polyps, the procedure goes faster. If they find polyps and remove them (that's how colonoscopies prevent cancer) it takes longer. Patient anatomical variations and other medical complications can affect the time required.
I run into the same thing with my patients. A simple 15 minute restoration on a cooperative adult patient can turn into an hour long ordeal on an uncooperative 5 year old, but insurance pays the same for either one.
The outdated data reared its ugly head in Ontario recently when the provincial doctors were negotiating with the province regarding pay. The province is feeling cash strapped and realized it should maybe update its pricing structure from the 70s. It is interesting that while they are moving doctors to more of a salaried model here, they are moving the hospitals towards more of a fee for service model (sort-of).
*woosh*
Depending on how bad the problem was either put the doc up on assault charges or on murder charges.
of course you could also have a third party run a listing of how many "errors" doctors have made.
To be fair with this list show the National Average Local Average also.
of course any fines should be split 85%+ to the "victim" and the balance to The State.
Any person using FTFY or editing my postings agrees to a US$50.00 charge
If a 15 minute colonoscopy costs 2000 dollars, or a 75 minute colonoscopy costs 2000 dollars it's the same thing.
What these articles are really pushing is to lower the pay of doctors by 75 percent. I'm not going to argue for or against that, but it's the actual argument here. Can we as a society give doctors and surgeons a 75 percent haircut on salary and still expect the same level of service.
Also what profession exists that charges no base time and at a 15 minute interval? Most IT people I know charge a 1 hour minimum even for a phone call, and a trip fee on top of that if they have to go somewhere.
If I have to go out and show someone how to reboot their computer by holding down the power button for 5 seconds it will be 85 dollars plus a 50 dollar trip fee even if that customer is 3 minutes away, and I'm there for 5 minutes.
We are talking specifically about how much time the doctor is working on the case of the patient.
The average time a doctor spends on a single patient isn't even close to the entire story. Bit of background: I'm an industrial engineer and also a cost accountant. I have degrees in both and have worked in healthcare doing six sigma projects, time studies and cost analysis.
1) Procedure times are NOT normally distributed. Not all cases are identical and some take considerably longer than the average. These longer cases typically are much more expensive. On a weighted cost basis the average cost will be higher than you would expect if you make the mistake of assuming a normal distribution.
2) You have to account for the time of the doctor PLUS the time of all the support staff. The time a doctor spends on a procedure frequently is not the biggest cost driver. My wife is a doctor. For the work she does her average time per case is about 10 minutes. For every minute she spends on a patient there is about 3-5 minutes of support staff time - sometimes more. On some cases she might spend an entire hour or more plus have to consult with other doctors for a particularly difficult diagnosis.
3) The value of a doctor's time isn't just driven by the average time for a procedure times some arbitrary hourly rate. What makes a doctor (particularly a surgeon) valuable is the value of his time when something unexpected happens. Patient goes into arrest on the operating table for instance. At that point the value of the doctor's time grows exponentially. If everything was just routine all the time, you could use nurse Now granted you can normalize the value of their time with enough study but the number you will get is going to be higher than if everything was routine and identical.
4) Time studies of procedure times are expensive and relatively difficult to perform. I've done a lot of time studies personally and trying to get an industry average for each and every procedure is far more difficult and expensive than most people realize. While there is no excuse for using outdated or wrong information, it is important to realize that maintaining an accurate and authoritative listing of expected procedure times is not a trivial exercise.
2 bitcoins?! That's putting a lot of value on your thoughts.
Just my 2 cents.
And by limiting the number of students accepted into medical school, they eliminate their own competition. The artificial shortage gets satisfied by foreign trained doctors (often US citizens forced to study abroad), who then get stuck with the worst residencies and jobs.
It's fracking Communist central planning fail.
Doctors routinely overbill (based on the insurance pay scale) or procedures knowing they will be paid less from insurance, but the higher billing amounts are factored in to what insurance will pay in the future.
"I believe in Karma. That means I can do bad things to people all day long and I assume they deserve it." : Dogbert
Uhm... duh, so stop having regulation that encourages people get what we call health insurance! Demand curves with "insurance" are notoriously steep. It seems like most of the regulation we've seen in the past several decades has been an attempt to further cement the idea that we should not have price preference and consumer choice in healthcare. That is not under-regulation, that is dysfunctional regulation!
I'm more interested in intelligent regulation. The current regulations are obviously a result of congressional bribery (Oh sorry, I meant "campaign contributions"). These benefit specific corporate interests and are blatantly anti-competitive. At the moment, neither party has the slightest interest in changing that, regardless of the ideology they publically espouse.
Please do not read this sig. Thank you.
This isn't just doctors, it's just cool to rag on them. Auto mechanic rates for different repairs are based on the use of only hand tools. I'm sure 99% of mechanics in the US are using power/pneumatic tools for repairs, so the time estimate is way off. The reasoning I've heard behind leaving the rates the way they are is so that rural mechanics can still compete with mechanics that have 'fancier' tools. This probably made sense before Harbor Freight made pneumatic tools dirt cheap, but you won't see the mechanics altering their price scale.
The doctors aren't the ones bringing home the money. It's the administration and the SHARE HOLDERS. The whole BUSINESS is a racket. This is also why the United States ranks the lowest overall in health care.
That's a nice fantasy, but it doesn't agree with reality. There is little difference between the rise in health care costs in partially regulated and fully regulated/nationalized systems. Therefore, there is no reason to believe that adding more regulation to the partially regulated US system is going to fix the problem.
(Dusts off Healthcare industry sysadmin cap)
It just so happens, I have a tiny bit of insight on this after sitting through a presentation by one of our Doctors which could have been titled "Why your department sucks because IT costs sunk my grant application".
Back in 1992, a proctologist stared through a scope and any video they did capture was crap by todays standards. Today, they are talking about very high resolution video, and a good sized department does a lot of these. Their data storage requirements just for these are huge (big enough to have sunk this Doctors grant application when the review said that it accounted for almost half of the proposed spending...about 40% if my memory serves)
Not to mention all of the other costs associated with maintaining an ongoing medical operation... training and retraining staff, equipment maintenance, data storage meeting DR and medical privacy requirements.
Outdated data is a problem but, its not really just about doctors pay or the amount of time it takes. Also, while the procedure time is shortened, it often involves heavy sedation, which means patients being given some time in a recovery bed to sleep it off for a little while (not long, but, it still uses up resources).
"I opened my eyes, and everything went dark again"
The 'Chargemaster' price list for nearly all hospitals and clinics is a closely guarded secret.
Ask to see the actual, list: good luck.
Have a receipt that you would like to argue (belonging to anyone other than yourself): 'We can't discuss that, HIPAA, and all that.'
Ask a doctor what the recommended procedure will cost: 'Blank stare.'
What other place can you go where they wont tell you the cost of the things you get until long after you have gotten the item (billed about 3 weeks later, often).
How can people make informed decisions without this key bit of information?
Put the doctors on salary.
The artificial shortage of doctors is a national embarassment and goes to the root of why you can't get a GP. There are thousands of perfectly qualified, intelligent, well-manners people who would love to be GPs and can't - because of entry restrictions protecting salaries.
Not much else to it. *shrug*
..don't panic
I've been saying this for a long time now and no one ever seems to listen. I'm glad someone is finally catching up. Here is a relevant comment I once posted
"Much of the problem is that in order for you to see a specialist, by law, you often need to see a generalist first and the generalist needs to refer you to the specialist. In many circumstances the generalist must be separately licensed to refer you to a specialist and those licenses need to be periodically renewed (more fees they must pay [& more time they must spend]).
See, for instance, Dr. Phil being unable to even refer you to a specialist because he's not licensed and so you can't see a specialist without first going to a licensed generalist. You can't even see a physical therapist without first getting a referral by a general practitioner and when your physical therapy session is up and you want to see the physical therapist again you must get another referral and pay even more money.
Lets not forget the fact that, here in the U.S., most everything is under prescription and so you need a prescription for so many drugs that are over the counter in other countries. This makes access to basic medications much more expensive."
http://www.techdirt.com/articles/20130502/07475922914/why-even-good-hospitals-doctors-are-obstacle-to-better-cheaper-healthcare.shtml
Hopefully people will start waking up to why costs are so high.
Aside from the question of how and when to update the 'time and motion' study data, does this setup the right incentives for the industry? It essentially says 'we will set the benchmark for adequate, and then you try to do whatever you can to beat it economically.' If the revenue at the margin is fixed, the way to drive profit is to decrease costs as much as possible. Of course, the benefits are not passed on to the consumer if the price fixer is asleep at the switch...
I am surrounded by doctors, professionally and personally, in multiple settings. And here's what the problem is:
They have an artificial monopoly over services, which inflates their compensation.
The problem isn't that they're evil, it's that many of the same tasks could be performed by other service providers for much less. It's a simple case of "government grants a monopoly, and you get inflated prices as a result." This permeates everything, so that MDs essentially control the health care market without any sort of competition or questioning. Recent battles over nurse anethestists and psychologist prescription privleges are just two examples where the same services could be provided by others for much less; greater freedom with physicians' assistants are others; so is a need to essentially eliminate drug control, illegal as well as legal.
To be honest, there *are* other fields where you go to school as long, and get compensated even less, and studying that long doesn't make you a good doctor.
Also, many of the factors you cite are arguably driven by this monopoly as well. For example, medical school tuition is raised that high partially because of this bottleneck in care--medical schools can charge this because physicans are guaranteed large salaries because of government-assured lack of competition. They work so long in part because of artificially created demand.
Think of it this way: right now the government prevents you from getting services, drugs, etc. from whoever you want. So lets say you want to go to an RN for antibiotics, or have your psychologist (who did neuroimaging studies of drug effects in graduate school) prescribe. You cannot. Moreover, you couldn't even if those individuals wanted to train as much as they possibly could to provide those services to you as best as possible, because the government makes it illegal. There's probably some harmless medication that you know how to take safely that you could go get from a pharmacist that you cannot because you need a middle man (the prescriber) to prescribe it for you.
What we have now is a cargo cult health care system, where people provide services under rules without any real concern for what's actually best or cheapest.
The reason why these reimbursements mentioned in the target article haven't been checked before is because MDs control so much of the health care system, and we operate every day assuming they know best, even though this isn't true.
Just to be clear: I'm not anti-physician (they're in my close family, and I think they do wonderful things). I just think that people should be able to choose whatever they want for health care, or at least have those services provided on the basis of skill, and not degree.
This pricing scheme and its failures demonstrate exactly why planned economies -- or in this case, microeconomies -- fail to work. No board of "experts" can possibly stay up to date on all of the best practices or prices. People who can do equivalent work with fewer resources through improved practices can have lower prices, forcing everyone to stay up to date or fail in the market. Medicare's pricing scheme actively blocks this, allowing enormous inefficiency to creep in over time.
Now I know everyone wants the best healthcare and they don't want to pay for it; however, doctors are literally in the business of selling life. We _need_ the best and brightest working there. The best way to accomplish this is by making the industry lucrative for the caregivers, so the field is highly competitive and pulls in the creme de la creme (not the fucking insurance companies, although the provide a valuable service as well). Government is not good at this, but the free market forces people to balance the cost of their care and taking care of themselves against other factors in their lives. Yes, there needs to be regulation to keep quacks out, and yes things are messed up right now, but do you really want your hospitals run like the post office?
What's the worst part about all of this? Now that we are trying to legislate lower prices, we can effectively guarantee that the best and brightest will not become doctors, causing an even bigger shortage, and thus raising the real price even more. We are sooooo fucked.
My wife is a board-certified family physician, and she does a lot of things an obstetrician does - deliver babies "normally" or through surgery (how does one spell "caesarian" anyway?) and does a lot of in-office procedures. Since she's not board certified in obstetrics, she is paid less for doing these procedures than someone who is so board certified. The work is identical and meets the same practice and safety standards - otherwise she wouldn't have hospital privileges to perform the procedures.
So why does identical work cost more depending on which professional organization certifies you?
If you can do the work, the hospital grants you privileges to do it, and the malpractice insurer is satisfied with the hospital's oversight process, then why shouldn't everyone be paid the same for the same work?
bingo, healthcare is regulated - rightfully so. Insurance is not. All costs for medical were transferred to ins., ins. began refusing claims, going up in price, setting up networks. Regulators start looking at ins. cos. and we now have the option of expanding the insured or watching the ins. companies start collecting and refusing to pay or collapsing.
except that you added a nationalized system, that is not jsut more regulation, that is more insurance, which the latter means more demand, therefore higher prices.
When you cant win, ad hominem.
I don't know what you mean by "you added". Do you mean the fact that the US added Obamacare means that prices go up? Yeah, they do, both for insurance and services.
"No more doctor shortages"
you clearly are unaware of the field of which you speak. Doctor shortage is in direct proportion to number of available seats in the residency programs. In US, we have enough foreign grads applying that were they all to start residency in 4-8 years we would not have the "shortage". The seats on the other hand have dramatically decreased in the recent years as the money for science and education along with the sequester has taken effect.
Now that is if all places to practice were created equal. Most doctors, like most people do not want to serve in a rural area. This is why city docs make a lot less (almost 40%) than their country brethren (exceptions of course exist). Some choose to go where the money is, some choose life style. This will not change.
please get off my lawn.
Every year, the med school cohort is about 20,000 per year (~80K in school at any given time https://www.aamc.org/data/facts/). The total bill for this (assuming your $250K/student/year) sums to $20 billion / year. In 2011, total healthcare spending was $2.7 trillion (http://go.cms.gov/13juHDi).
Actually, it's closer to $250,000 per student over four years.
http://gradschool.about.com/od/medicalschool/f/MedSchoolCost.htm
I would like to know if they calculated that per school or per student.
Hourly billing penalizes efficiency, improvements and outcome. Do you really want a doctor that spends an hour on your colonoscopy if a better process can get better results in 2 minutes with less discomfort? With time based billing, the doctor taking an hour gets paid more than the one taking 2 minutes, yet the patients experience would be improved with the shorter duration.
Gods yes, I do.
First, not all colonoscopies are created equal, nor are all surgeries or surgeons. If you pay the same amount for a procedure regardless of the time, then it discourages doctors from performing thorough procedures, and when you're dealing with cancer, you would rather have the thorough procedure.
Doctors are busy enough that they aren't going to start overbooking time just because they're paid hourly. And I would be willing to trade slightly higher costs for transparent costs. Going to a doctor now is like going to a restaurant with no prices on the menu, where the waiters can guess at the prices but your chef will tell you what they actually billed you a few months later, and nobody will be able to tell you what is actually in the food.
Transparency rocks. Medicine is not transparent.
anti-trust laws and specific legislation prevent hospitals and doctors for sharing price information (aka Sherman Anti Trust Act [wikipedia.org])
Bullshit. Nothing prevents them from sharing price information and from setting prices in a competitive market. What they are not allowed to do is *conspire to set prices a certain way if they're competitors*, at least not without an act of Congress or (possibly) approval of the courts. Certainly every insurance company and hospital could be transparent--set prices for everything and post them on their web sites. Adjust them periodically to make them more competitive. That's perfectly legal.
They just can't agree amongst themselves not to set the price for X no lower than value Y.
In fact, if prices were transparent, they would have a more competitive market. That would not be in restraint of trade, but would promote trade, and I'd be willing to argue that in any court in the country.
It means that combined, as in added, both regulation and nationalization (IE insured). 2 seperate issues, but you failed to break out the one responsible. One, the insurance, I blamed already.
When you cant win, ad hominem.
Yes, do you not see that it's the very regulation you espouse that is part of the problem?
Or are you one of those people who see all regulation by our benevolent government as good? If you are one of those people, then no amount of discussion will change your mind. Just keep adding rules and regs until you naively watch it collapse in a pile of ashes.
They are not separate issues; nationalization is the ultimate in regulation.
They are separate issues which can be combined at some point. In our case the issue with be with the mandate of insurance.
When you cant win, ad hominem.
Supposing we do something that ties the rates doctors are paid to the amount of time they spend doing something. The next batch of things we become incensed and appalled about will be how they always take too long to do something. That is, if we pay more when things take longer. Why shouldn't we pay the doctor the same amount for a procedure if they figure out a way to do it better or faster or with less side effects or a smaller possibility of significant damage? Perhaps its a little much to pay for 75 minutes, which it took 15 years ago, instead of the 15 minutes it takes now. But paying for just the 15 minutes is a recipe for disaster. People will maximize their own benefit. Things won't become better and faster and safer. That's just the way it works. Additionally, there has got to be some range of effectiveness in medicine. Some doctors, surely, can do a good job on a particular patient in 10 minutes while another will take 20 to accomplish the same thing or 10 to do a crummy job. To some degree, those that do poor work will eventually be weeded out or see their practice decline to some degree. Word does get out. People talk. The summary mentioned someone who got 26 hours worth of doctoring done in one day. Should we not reward him or her for efficiency. I see it as better when I get things done in less time than someone else provided I do a good job. Why would it be different for doctors? I'm not making any attempt at being fair minded here. The arguments for the other side of this are plain and well enumerated so far. But there's more to it than that. Be careful what you measure. Its true in software development and true in medicine.
As a practicing physician for 26 years, I have to wonder why almost all new physicians feel they have to accept employment from hospitals and similar entities (including insurance companies) as they come out of training. Physician reimbursement makes up a small percentage of the money paid out by Medicare and insurance companies. Drug companies and hospitals take the majority of payments. The cost of regulatory compliance, even in a small physician office, is becoming overwhelming in both time and money.
How I miss the days when I could concentrate on practicing medicine and caring for my patients. This will not be a problem for me soon enough, but I pity the patients of the future whose doctors will serve their employers above their patients. The government in league with insurance companies and "health care" corporations has created this mess, and they have no desire to fix the problem,
I will give you a virtual mod point. I have actual ones but usually everything you say pisses me right the fuck off! Just because you pulled one gem from your ass doesn't mean you aren't gonna turn around an fuck the dog in the next one. Besides I think I hear you supporting Obamacare just now, when I know historically you shout it down whenever possible. Is it retro cool now to love Obamacare? Fucking hipsters.....
You're neglecting a fundamental difference between being a healthcare provider and other professions such as IT.
In many healthcare situations, we make irreversible changes to another human being that if done incorrectly can result in serious consequences, up to and including loss of life. It takes many years of preparation and personal sacrifice to reach a level of knowledge and skill that allow one to be granted the trust and privilege to perform such work. Yes, we are paid a bit bit higher than some other professions, but much less than many others. Some of my classmates incurred debt of >$300k to get through dental school, at 6.8 - 8.5% interest to be repaid in 10 years. For many that is >$3000 per month in student loan repayment.
I don't know where you get the idea that dentists are overpaid or greedy, but I am sorry you feel that way. I think you may be a victim of the insurance industry's attempts to put the blame for high healthcare costs on the providers. This works for them as they try to drive down their payments to providers because that increases their profits. Provider fees are actually a small fraction of the total cost of healthcare in the US.
If you think healthcare costs too much, I suggest that the next time someone presents you with a petition in favor of a single-payer system you consider signing it. I know, Rush (or Hannity, or O'Reilly) told you that that would be "socialist" or "big government" so it's bad, but consider this: the insurance industry exists to make profits. They do that by a) raising premiums that you pay for care and b) denying payment for the care you receive (and paid for). They have no incentive to deliver any health care whatsoever and employ armies of lawyers to lobby congress and state legislatures to maintain their grip on your wallet. A single payer system tasked with delivering healthcare would employ an army of people whose jobs are to ensure that payments are going to delivery of healthcare and not fraud. In either system you employ an army, in the former, the army works against you, in the latter the army works to make sure payments go to healthcare and not fraud. The latter situation sounds a LOT better to me.
The thing that really seems to pique their interest is any discussion of how much money they'll be making.
Sweet jesus. That doesn't describe me at all. Furthermore, anyone who is going into medicine as a future physician for the money (in the USA) should be rejected on principle.
Not because it's wrong to have pecuniary interests, but rather because you have to be retarded to want to become a physician if your goal is to get rich—and the last thing we need in medicine is more retarded practitioners. If an applicant/student isn't competent enough to have figured that out by now then I don't want them as a peer because they are likely not very intelligent at all.
The health care system in the USA is fucked. Get ready for most of your care to be handled by midlevels.
If anyone is considering becoming a physician to get rich, stop now and do the background research. Understand the opportunity cost and time value of money, as well as the probability of the future government lock-in of healthcare practice while you are still a slave to your educational loans that aren't dischargeable in bankruptcy.
I anticipate I will be one of the few future physicians who end up actually satisfied. I'm doing this out of intellectual curiosity and because I find the subject fascinating. Oh, and I could also easily fall back on several other proven careers if practice gets truly shot to hell in ~10 years. I pity the others though... lots of disgruntled, residents/newly minted docs out there.
You do realize that residents get paid? And they get paid MORE then most bunny lawyers, all vets, or humanities PhDs? [...] They are incredibly out-of-touch. They personify the upper-crusty-arrogant attitude that $40k is not enough to raise a family.
This is an *extremely* poor choice of crowd to target your proletariat rant towards, man. Let me spin this fucker for you a different way: you can bust your ass for four years through medical school, accrue several hundred k in debt, then for the next four years as a resident you make less than half of what a decent software dev can easily make (40k vs 80+k). Then, once you start practicing as a physician, you have quality of life issues that developers don't have and are burdened with massive charges in malpractice insurance which saps your actual net. This is coupled with everyone presuming you're rich and hitting you with "fuck you" tax brackets ("Oh? You wanted to deduct your student loan interest from your income? Ha ha ha. Fuck you...").
Anyway, like I said, if you busted your ass just as hard to climb the corporate ladder as a software dev then I bet you would come out ahead in terms of lifetime income. Yeah: four years of zero income/lost earning potential, hundreds of k in debt, followed by four years of salary that someone with a BS in CS can pull straight out of college? Shit man, I guess you're right: every physician has their own personal hedge fund and vulture capitalist firm... because that's *bank*. Where do I sign up?
Your rant would play better at your local unskilled labor watering hole. I suggest you try again there.
Re outdated rates. Do the rates include pre operative preparation -- steralizing the operating table, wiping down cabinet knobs, clean towels, etc. And does it include cleanup immediately after. Of course the doctor does not do it. But if he was in the boonies, he would do all three, pre and post and operate.
The system is, however being milked. Most general doctors after 3 years following internship become nothing more than skilled triage experts. They can do triage and send you to the specialist. Do you really need a doctor for that triage assessement, or can a skilled nurse do the job as well.
Leslie Satenstein Montreal Quebec Canada
The U.S.A expends ~17% of its G.D.P. in health while all other O.C.D.E countries expends far less and mos of them (including Mexico, which sort of kind of have universal coverage) have better coverage.
That can't be. It wasn't modded funny.