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You do realize that a pediatrician typically doesn't administer "shots".
yes, i do. the nurse typically does it. but if the nurse does it wrong, you sue the doctor's office. i'm just providing some examples of situations where one may want to sue the bastid!
I know a lot of doctors and have family in various medical fields. Virtually every doctor i've personally dealt with has no business acumen at all, and they are often too cheap to hire an office manager that is competent. So, they have bills that sit unpaid for months and years, though they spend a fortune sending follow ups to those unpaid bills. I've actually been not able to pay for a service on the day I received the service, even though I wanted to.
Hospitals are often horrendously managed also. And if you're any sort of sub-contractor, don't do any work for a hospital unless it's essential work. Hospitals will put off paying guys like painters but will always pay the janitorial service.
I have sympathy for family physicians and general practitioners, but most specialty doctors i've encountered in the northeast region are doing quite well, financially speaking.
If they are such poor businessmen, why are they doing well? Why is a family practitioner more likely to do less well? I suspect it has more to do with poor reimbursement.
You may not be able to pay on the day of service because your share of the bill cannot be determined until after the insurance pays. If they spend a fortune on follow ups to those unpaid bills, it is because the patient did not pay when the first bill was sent, right? Whose fault is that?
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Originally Posted by bradykp
i dont know if you know many doctors or not, but very few are underpaid, if you're in the topic of specialty doctors. and my sister worked for a doctor who billed insurance companies for basic tests he didn't perform, because it's not something the patient would ever notice (i.e., checking lymph nodes, etc.). the "sue happy society" accounts for something like 0.5% of healthcare costs...it's just an easy topic to discuss so we're made to believe it is more prevelant than it is.
Did your sister report the insurance fraud? Was she actually responsible for billing? "Checking lymph nodes" is part of a physical examination, not a "test." It is not something that would be billed for separately. Perhaps your sister just does not understand medical billing. If the patient did not notice billing for something wonky, I guarantee the insurance company would.
Imagine that? Getting a degree or training in something of value so you can have a better life. In a former thread someone was asking about why some people from other nations make it and others don't. The discussion came down to Philippinos and Mexicans. I wrote in a post that at our Hospital if you were to see a Philippino chances are they work in Nursing, Radiology, the Lab or some other field that has education as a point of entry, while if you were to see someone from Mexico they would more than likely be working in Environmental Services, the laundry, or food service, jobs that have no formal education attatched to them.
good points, but I wouldn't sell Mexican culture short either. They are vastly improving their family's lives with those jobs, and they have very hard work ethic. chances are their children will be doing something better than Environmental Services. They don't really have the same access to training in Mexico than in the Phillipines. And...if you go outside of the city centers in the Phillipines, you'll find it very similar to virtually all of Mexico...very poor, agriculture, etc. It's all relative, i guess is what i'm saying...
For those that want to move to Cuba or some other Third World nation for your healthcare because it is so cheap and it cost so much more here in the United States realize that you get what you pay for. We have the best in the world.
The bed that you will be staying in at our hospital monitors your weight, movement, helps resist body sores from staying in a bed too long, sends a signal to medical staff when things are going bad or when you try getting out of bed, sends a message to the Doctor about your current care.
That RN and CNA that are caring for you are charting on Ipods and Computers and everything that is done for your care is put down, not on paper but on an electronic chart. The information from your bed, including your every movement in the bed is sent to the computer as well. Any food that you ate or medication that you took is listed.
When a medication is given to you the machine that will dispence the medicine will chart that you have been given the medicine and the RN will chart that it has been administered. Not even so much as a bandaid is not accounted for and listed as being unsed on you for your treatment. This information is listed on your chart as well.
If you need an X Ray, MRI, CT Scan, Pet scan or any other scan that information is sent to your chart.
Lab samples are taken to diagnostic equipment and results are given in minutes. The fact is that anything being done now is done in minutes instead of hours, days, or weeks.
Many high end surgery's are now performed with a robot system that is minimally evasive and lets you recover faster.
All information can be looked up by your doctor on his phone, iPad, or computer and information on treatment options can happen at the time a result is given, meaning that if you give a blood sample the doctor will have the results back faster than you would think possible. Our medicine is fast pase and results oriented. If a specialist is needed they can be called in to look at the results from anywhere in the world and it can happen in minutes. Doctors are not free to play golf and treat patients at the same time.
While all that is going on our Health Information Management Department is drawing the information together, Billing Department can bill your insurance for the exact items used and time spent within the Hospital. Medicine just is not what it used to be.
Still for those that want to, head on over to your favorite 3rd world nation and take in the cheap medicine. Just remember that you just can't compare what is happening today in the USA
This doesn't describe many of the hospitals in NJ. If every hospital had this level of use of technology, then I'd somewhat agree. No one needs to go to Cuba for comparison when you have places like France, Germany, and Switzerland who all do it better and cheaper. Let's not pretend ours is the best when it's not. It's very good, but it's simply not the best.
Nurses have very strong political influence in California and their support is often sought for various measures.
Nurses wages vary greatly from region to region and even more so around the country.
One thing I do find odd is that Nurses have carved out a special exemption in the labor law when it comes to overtime requirements... where as many other professionals are exempt from being paid overtime in most cases... it is just the opposite for Registered Nurses.
For years, I have urged family and friends thinking about career paths to consider Nursing... many dismiss it because they have no idea the opportunities Nursing Provides...
For the record... we have Nurses with Diplomas (Learned on the Job), those with AA degrees and those with BSN or higher working at my facility as well as travelers and foreign born... one graduated in Germany and was able to challenge the California Board and was granted her California RN license...
Don't forget the California also has a provision for military corpsman to challenge also... the military has been the path for several here...
High Medical Costs are not due to any one item... they are a result that just about everything medical is expensive... a million dollar per bed to construct a local hospital... equipment costing hundreds or thousands of dollars becoming obsolete a few years out, the cost of providing free care for some at the expense of others, the cost of government mandated compliance... combined with declining reimbursements... and you get an idea why some Hospitals are closing.
I do know several Doctors that work as Operating Room Nurses... and they love it.
They no longer have the responsibility of being an employer, running an office with all that entails, the high cost of malpractice and they can easily schedule time off without impacting others...
Many services provided in a hospital are provided elsewhere for a fraction of the cost. I would like to reference the nytimes article I posted earlier about St Vincent's in NYC. Bottom line, we need to get smarter about our care and treatment, and we need more preventative care.
If they are such poor businessmen, why are they doing well? Why is a family practitioner more likely to do less well? I suspect it has more to do with poor reimbursement.
You may not be able to pay on the day of service because your share of the bill cannot be determined until after the insurance pays. If they spend a fortune on follow ups to those unpaid bills, it is because the patient did not pay when the first bill was sent, right? Whose fault is that?
Did your sister report the insurance fraud? Was she actually responsible for billing? "Checking lymph nodes" is part of a physical examination, not a "test." It is not something that would be billed for separately. Perhaps your sister just does not understand medical billing. If the patient did not notice billing for something wonky, I guarantee the insurance company would.
you're right about poor reimbursement. the reason why they still do well is because they see that many patients. I see numerous doctors who could be doing better though, if they managed their office more efficiently and effectively. I still see many offices with zero use of computers. Scheduling, file management, billing, would all be done in less time and less errors if they utilized a better system. Family practitioners cannot charge as much as specialty doctors, even if the services are the same.
I cannot even pay my copay on the day of service - and that amount is known whether or not the reimbursement amount is known. Again though, even with the insurance billing, with today's technology, this should be much more efficient and streamlined.
Mail gets lost in transit, misplaced in a house, forgotten, etc. It's always better to get the money in the beginning vs. later. Plus, every day that cash is not in your pocket, you lose money on it. It's why companies like AT&T and Verizon want you to set up for "autopay" so they can deduct your bills on your due dates. Cash flow management, depending on the size of the operation, can add up to big differences in profits.
My sister had no proof other than her word. Maybe my example is a bad one, but she described it to me a while ago. She left the practice because of the doctor's ethical behavior. There are items the doctor checks off and then bills for that he didn't actually perform. It's not wonky, that's the point...and the doctor knows it. It's simple, minute stuff, that he just doesn't do but bills for anyways. He's an orthopedic surgeon, so it's stuff he doesn't really need to do in any given visit, but there's no issue saying he did it. It's anecdotal, I know. But it doesn't sound very surprising either.
This doesn't describe many of the hospitals in NJ. If every hospital had this level of use of technology, then I'd somewhat agree. No one needs to go to Cuba for comparison when you have places like France, Germany, and Switzerland who all do it better and cheaper. Let's not pretend ours is the best when it's not. It's very good, but it's simply not the best.
Better? Cheaper? Not sure on either. Those are heavily taxed places if I remember and the people are paying for it if they need it or not.
good points, but I wouldn't sell Mexican culture short either. They are vastly improving their family's lives with those jobs, and they have very hard work ethic. chances are their children will be doing something better than Environmental Services. They don't really have the same access to training in Mexico than in the Phillipines. And...if you go outside of the city centers in the Phillipines, you'll find it very similar to virtually all of Mexico...very poor, agriculture, etc. It's all relative, i guess is what i'm saying...
I agree with you and see it as more Mexican's and even other Latino's go into the profession. My wife is in Nursing and our Daughter and one son want to be RN's.
Many services provided in a hospital are provided elsewhere for a fraction of the cost. I would like to reference the nytimes article I posted earlier about St Vincent's in NYC. Bottom line, we need to get smarter about our care and treatment, and we need more preventative care.
I'm all for getting smarter...
Recently I had a personal experience that showed just how inflexible the system can be.
I was helping a friend build his field-stone block wall on a Sunday... one of the 70 pound stones slipped and landed on my big toe...
I did all the normal things like alternate ice and and such...
Early the next morning it was not looking too good... called my HMO and was told it would be 5 days till the Dr. could see me... I said I need to be seen this morning... just had a sock because the swelling was too great.
Anyway, the Doctor's office tells me to go the ER... which takes the better part of a day and cost me $400 out of pocket if I am not kept overnight.
Just then, one of the in-network podiatrists sees my plight and says he wants to see me in his office in 10 minutes... takes x-rays and determines I crushed it badly... not broken.
Anyway... my HMO is furious I didn't go to the ER even though the Podiatrist is in network
Podiatrist charge to me was $280... much less then the ER...
I raise a fuss with HMO and they scolded the Doctor for sending me to the ER... and agrees the Podiatrist visit is medically necessary and reasonable and I pay the $40 co-pay and Doc takes less than the $280 charge...
Sometimes, the inefficiency of the system seems designed to do anything but take care of the patient...
you're right about poor reimbursement. the reason why they still do well is because they see that many patients. I see numerous doctors who could be doing better though, if they managed their office more efficiently and effectively. I still see many offices with zero use of computers. Scheduling, file management, billing, would all be done in less time and less errors if they utilized a better system. Family practitioners cannot charge as much as specialty doctors, even if the services are the same.
I cannot even pay my copay on the day of service - and that amount is known whether or not the reimbursement amount is known. Again though, even with the insurance billing, with today's technology, this should be much more efficient and streamlined.
Mail gets lost in transit, misplaced in a house, forgotten, etc. It's always better to get the money in the beginning vs. later. Plus, every day that cash is not in your pocket, you lose money on it. It's why companies like AT&T and Verizon want you to set up for "autopay" so they can deduct your bills on your due dates. Cash flow management, depending on the size of the operation, can add up to big differences in profits.
My sister had no proof other than her word. Maybe my example is a bad one, but she described it to me a while ago. She left the practice because of the doctor's ethical behavior. There are items the doctor checks off and then bills for that he didn't actually perform. It's not wonky, that's the point...and the doctor knows it. It's simple, minute stuff, that he just doesn't do but bills for anyways. He's an orthopedic surgeon, so it's stuff he doesn't really need to do in any given visit, but there's no issue saying he did it. It's anecdotal, I know. But it doesn't sound very surprising either.
This is true about many physicians having trouble running an office. I have first hand knowledge of this and am aware of many doctors who have either become employees of hospitals and/or sold their practices to a hospital. It has become difficult for a sole practitioner to survive. The staff needed to run an office, the number of patients that must be seen, and the need to make hospital rounds all impact a physician practice's profitability.
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