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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.
I've never been unable to pay my copay at the time of service, so I do not know why you have doctors that do not want to accept it.
I also do not know any doctors who do not use computers for billing, accounting, and scheduling. Most have to do it in order to file insurance claims. If there is a problem with computers, it's that some insurance companies want to charge a fee for computer claims. Medicare actually requires that it be done with dial up internet service.
There are incentives for doctors to use electronic health records, although there is evidence that EHRs actually interfere with patient care by directing the doctor's focus from the patient to the computer. We do not want people to text while they drive, but somehow it's great to have the doc type on a computer keypad rather than look at the patient while he's talking to her. I know a psychiatrist who paid $30K for her EHR and hates it.
Believe it or not, medical offices could be quite efficient thirty years ago with paper charts, an appointment notebook, a pegboard accounting system, and patients who paid for their own care.
I still do not think the doctor your sister worked for is typical. He will eventually get caught, and he will face stiff fines and possible criminal prosecution. A local nursing home owner here is going to prison for a long time for Medicare fraud.
Just a quick comment or two. I've read several comments by nurses and family members of nurses who vigorously protest that salaries of $80,000, $90,000, and $100,000 are not contributors to high health costs. Of course, these figures don't take into account the cost of the benefits that the nurses are earning along with their salary either which presumably include health insurance and a pension plan of sorts whether it be 401K or a defined benefit plan.
Yes, you are contributing to high health care costs whether you realize it or not. I suppose a doctor earning $400,000 a year could tell me the same thing. All these salaries are considerably above average. Healthcare workers do have specialized training and that's because we Americans want good, safe treatment for our medical problems. Don't kid yourself though. These are all heavy "cost drivers"
All other fields of business are experiencing efforts to reduce costs by hiring lower salaried people with lesser skills. Its unreasonable to expect the medical field to be immune to this. America is literally bursting at the seams from high healthcare costs that go up by 6% or more a year.
I appreciate nurses too. But, stop this "snow job" in which you try to delude others and maybe yourselves that your salaries are not part of the problem.
See post # 44 in this thread. Even including the costs above salaries, nurses only account for about 5% of health care costs.
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!
But you had indicated in your other post that the physician would lose her license...which would be an erroneous claim if she didn't order/administer the wrong shot.
I've never been unable to pay my copay at the time of service, so I do not know why you have doctors that do not want to accept it.
I also do not know any doctors who do not use computers for billing, accounting, and scheduling. Most have to do it in order to file insurance claims. If there is a problem with computers, it's that some insurance companies want to charge a fee for computer claims. Medicare actually requires that it be done with dial up internet service.
There are incentives for doctors to use electronic health records, although there is evidence that EHRs actually interfere with patient care by directing the doctor's focus from the patient to the computer. We do not want people to text while they drive, but somehow it's great to have the doc type on a computer keypad rather than look at the patient while he's talking to her. I know a psychiatrist who paid $30K for her EHR and hates it.
Believe it or not, medical offices could be quite efficient thirty years ago with paper charts, an appointment notebook, a pegboard accounting system, and patients who paid for their own care.
I still do not think the doctor your sister worked for is typical. He will eventually get caught, and he will face stiff fines and possible criminal prosecution. A local nursing home owner here is going to prison for a long time for Medicare fraud.
Electronic records have been around for decades... I know an orthopedic surgeon without a single file cabinet in his office...
He did loose several laptops when his office was burglarized... police were there in less than 5 minutes and it was too late.
Another Doc is on his 4th system... he is an early innovator and won a lawsuit against one of the firms and another went out of business.
It is a nice thought to simplify by going paperless... much more complex and costly then one would think...
The hospital where I work had to junk the system they had... it was no longer supported by the manufacturer... worked well and was simple and used Windows 95...
The licensing fees can easily be hundreds of thousands of dollars and then there is all the hardware upgrades and maintenance, back-up and security
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.
What sort of simple minute stuff was he billing for that he wasn't doing? Maybe you could ask your sister what sort of simple minute procedures the orthopedist would be nickling and diming someone with. I don't know I find it pretty difficult in a field like that one could routinely charge for things that weren't done, without getting caught. I'd need to hear what was simple minute stuff I guess to believe it...a lymph node check is a part of a basic assessment...not billed separately.
Wrong. Wrong. Wrong. Those malpractice suits that you and several others claim are allegedly responsible for out-of-control healthcare costs are responsible for approximately 1% of all healthcar5e costs. This includes both malpractice insurance costs and the cost of practicing defensive medicine. By way of comparison, healthcare costs overall increase by 6% or more per year. So, if we totally eliminated all lawsuits for malpractice and all malpractice insurance, you wouldn't even see the difference in your medical bills.
Don't take my word for it. Read the study done by the Congressional Budget Office about this problem. The CBO is a better source for this than your opinion or that of several other posters on this thread. Do us all favor, if you are going to continue to "beat this drum" have the integrity to respond to my argument and at least read this study first. Otherwise, don't expect to be taken seriously.
Finally, understand that reforms which eliminate or reduce these lawsuits will damage the one control that exists on the quality of medical practice outside the medical system itself. Do you really want to leave quality control entirely up to physicians and hospitals? I don't want the fox guarding the hen house, but than I'm 53 and I've lived long enough to understand the problems involved with something like that.
you'll find a range of numbers, but none really go higher than 2% of overall spending. the awards/settlements you read about in the news are often severely reduced by the courts. even the famous McDonald's hot coffee award was substantially lowered.
Many different types of businesses have to deal with getting sued on a regular basis, not just doctors.
But hey...if you want tort reform, feel free to sign up and define how much you personally would want an award capped if a doctor amputated the wrong leg, or if a surgery left you paralyzed, or if a steroid injection gave you menengitis and killed you...i suspect most people wouldn't volunteer for a limit on those things though...
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Originally Posted by bradykp
well, maybe you're right. but personally, i'm not willing to subject myself to a limit on a doctor screwing up my ability to walk, or talk, or see, or feel, or taste, or live. bottom line though...if there is negligence, they need to pay up. if there is not, the courts typically toss those cases out before they get anywhere.
who sets the limits in your world? let's say, i wanted to make the penalty for cutting off the wrong limb $1,000 fine...you ok with that?
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Originally Posted by bradykp
well, let me know some examples of limits you're willing to set. say, for instance, you took your daughter to the pediatrician for a shot next week, and the pediatrician killed your daughter because she worked too many hours, had the flu, and came into work anyways, and then injected the wrong medicine into your daughter....what's the dollar limit you'd be willing to accept as a penalty for that doctor? or, maybe no dollar penalty, maybe the doctor just loses their license?
I read the CBO article. The bottom line appears to be that no conclusion could be drawn because there were too many variables.
Ask doctors whether they are doing unneeded tests to cover their backsides and see what they say. Go to your primary care doctor with a headache that has classic features of migraine and you'll probably get treated for migraine headaches for the cost of an office visit. Go to the ER and you will probably get the $3000 to $5000 workup just to make sure you do not have a brain tumor. After all, you were sick enough to consider it an emergency, were you not?
The difficulty with medical liability insurance is that the person who ultimately receives the payout in a malpractice suit does not understand that the money for that award does not come out of the doctor's pocket or the insurance company's coffers, but the pockets of people paying for health care and paying for health care insurance. Juries do not understand that when they award $10 million, next year their employer is going to be paying more in health insurance premiums and the workers can forget about a raise. The $300,000 annual liability premium for a neurosurgeon has to come from somewhere.
As far as limits on awards is concerned, the focus is on money for "pain and suffering." The only limit on those is how eloquent a plaintiff's attorney can be. Half of that money will go in his pocket, so there is plenty of incentive to be very eloquent.
Other estimates put spending on medical liability, including defensive medicine, at between 2 and 10% of total cost:
Liability premiums are strongly dependent on geography. 2011-2012:
OBGYN Rochester area, NY: $36,166 per year; Long Island counties, NY $181,132; Miami and Philadelphia are even higher. California, Fresno area, $15,484 per year.
The difference? CA has comprehensive tort reform with a cap on "pain and suffering" and provisions to prevent plaintiffs for recovering expenses that have been paid by other sources, including health insurance.
The fact is that we all pay for a system that is going to pay a very small number of people astronomical amounts of money. People who are injured through medical errors should be compensated, but we do have to set limits. We set limits every day. How much life insurance do you have? You choose an amount at the premium you are willing to pay, right?
Should the person who is injured by a physician receive a larger award than the person who has exactly the same disability as someone who is injured in an automobile accident? Right now, the doc will pay more, because he buys higher limits of coverage. Would you be willing to pay more for automobile insurance so victims who are killed or maimed in accidents can get higher awards?
As for the subject of suing, that's the result of having a society with an inadequate social net. When something happens lives often get ruined beyond the obvious medical injury.
Often the result is that someone needs additional treatment, can't work as a result of the injury or perhaps someone dies.
If the person working needs additional treatment, who will pay for that? He won't be able to work, loses salary, loses health insurance. The whole family is dragged into poverty, can't cover the medical bills >bankruptcy.
The main earner dies () () () > bankruptcy and poverty. And so on.
That is the reason people sue, there's no adequate welfare, no adequate healthcare for the poor. One's whole life can just collapse in a matter of days.
So yes, the insurances pay. So doctors have to pay huge premiums. In Addition to ridiculous student debt. Because getting the education is ridiculously expensive. Another problem in the system. So of course they charge more, do more tests, it is a financial necessity.
It doesn't have to be this way but it is this way and it's more than just sue happiness, at least in this area.
As for the subject of suing, that's the result of having a society with an inadequate social net. When something happens lives often get ruined beyond the obvious medical injury.
Often the result is that someone needs additional treatment, can't work as a result of the injury or perhaps someone dies.
If the person working needs additional treatment, who will pay for that? He won't be able to work, loses salary, loses health insurance. The whole family is dragged into poverty, can't cover the medical bills >bankruptcy.
The main earner dies () () () > bankruptcy and poverty. And so on.
That is the reason people sue, there's no adequate welfare, no adequate healthcare for the poor. One's whole life can just collapse in a matter of days.
So yes, the insurances pay. So doctors have to pay huge premiums. In Addition to ridiculous student debt. Because getting the education is ridiculously expensive. Another problem in the system. So of course they charge more, do more tests, it is a financial necessity.
It doesn't have to be this way but it is this way and it's more than just sue happiness, at least in this area.
But very few people end up in the situation you describe because of medical errors.
The liability system provides no recourse for those who have catastrophic illnesses that are either no one's fault or the patient himself was at fault, such as being injured in an automobile accident you caused yourself.
I know an obstetrician who got a request for medical records from an attorney once on a patient he cared for during her pregnancy and delivery. The child had cerebral palsy and was not doing well in school.
The delivery? Mom had a Cesarean section with no labor. The obstetrician did not hear another word from the attorney.
Had the mother gone through labor, the obstetrician likely would have been sued and lost, though he did nothing wrong.
The solution is to scrap the whole liability system and come up with something that provides help for people based on adverse outcome, not fault. The vaccine compensation fund does that for people who truly have adverse effects from vaccines.
That will never happen, though. People prefer to be able to play the tort lottery and there are too many lawyers who will never allow it.
The liability system probably costs us a lot more than paying nurses reasonable salaries does.
I read the CBO article. The bottom line appears to be that no conclusion could be drawn because there were too many variables.
Apparently, you don't read well than. The article specifically drew the conclusion that the total cost of the tort system in medical care was less than 2% of total expenditures. More importantly, the article discussed in detail the concern that malpractice causes physicians to practice "defensive medicine" and order more tests and procedures because they supposedly are afraid of being sued if they do not. States with tort reform in place were compared with states that have no tort reform in a study involving Medicare patients. The results? Just as many tests were ordered in states with reforms in place such as California of which you speak later
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Ask doctors whether they are doing unneeded tests to cover their backsides and see what they say. Go to your primary care doctor with a headache that has classic features of migraine and you'll probably get treated for migraine headaches for the cost of an office visit. Go to the ER and you will probably get the $3000 to $5000 workup just to make sure you do not have a brain tumor. After all, you were sick enough to consider it an emergency, were you not?
Anecdotal. This means nothing without statistical or empirical support. The article I've quoted has looked at the very thing and they find that support non-existent.
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The difficulty with medical liability insurance is that the person who ultimately receives the payout in a malpractice suit does not understand that the money for that award does not come out of the doctor's pocket or the insurance company's coffers, but the pockets of people paying for health care and paying for health care insurance. Juries do not understand that when they award $10 million, next year their employer is going to be paying more in health insurance premiums and the workers can forget about a raise. The $300,000 annual liability premium for a neurosurgeon has to come from somewhere.
No, it comes from the pockets of other doctors insurance premiums. There is some logic at work here. Under traditional economic principles, a competent doctor will pay market prices for malpractice insurance. An incompetent doctor will pay more over time and may eventually have to leave medical practice. That's the notion of passing costs on to those who are responsible for harm. Its a basic principle of tort law. Insurers don't have to write a policy for any doctor. If someone stands out over time as a "bad apple" due to excessive claim payments. He/she won't get insurance.
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As far as limits on awards is concerned, the focus is on money for "pain and suffering." The only limit on those is how eloquent a plaintiff's attorney can be. Half of that money will go in his pocket, so there is plenty of incentive to be very eloquent.
You obviously don't much about the issue you are talking about. I practice personal injury law, but have not taken a malpractice case in the last fifteen years. My primary interest in this issue is that I dislike those who distort or exaggerate the facts to obtain an agenda of limiting patient rights and enriching corporate America at our expense.
Most importantly, I can tell you right now that pain and suffering claims are a small part of jury awards for malpractice. Most of the significant awards are for future medical expenses (which are astronomical in a catastrophic injury case) and for things like rehabilitation and even home care expenses. Sometimes, its lost earnings capacity when a client is injured so badly he can no longer work.
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Other estimates put spending on medical liability, including defensive medicine, at between 2 and 10% of total cost:
The 2% figure is close to what the CBO quotes. In any event, CBO is a more reputable source than what you have quoted here.
Liability premiums are strongly dependent on geography. 2011-2012:
OBGYN Rochester area, NY: $36,166 per year; Long Island counties, NY $181,132; Miami and Philadelphia are even higher. California, Fresno area, $15,484 per year.
Quote:
The difference? CA has comprehensive tort reform with a cap on "pain and suffering" and provisions to prevent plaintiffs for recovering expenses that have been paid by other sources, including health insurance.
Why do you think someone's health insurance should be counted as a source of compensation? Unless its Medicaid, the injured person paid the premiums for it. In effect, MICRA and similar legislation thinks that private health insurance should subsidize bad medical practice. That's ridiculous on its face. I can tell you that health insurance premiums and health care costs are very high in California. So, if the docs are getting a "swinging deal" on their malpractice insurance, the consumers and patients have little to show for it.
The fact is that we all pay for a system that is going to pay a very small number of people astronomical amounts of money. People who are injured through medical errors should be compensated, but we do have to set limits. We set limits every day. How much life insurance do you have? You choose an amount at the premium you are willing to pay, right?
A jury of your peers gets to say how much your case is worth. That's a fundamental right given to us by the Constitution. Its hardly radical. Juries actually refuse to award money in somewhere between 2/3's and 3/4's of all medical malpractice cases that are brought. That's hardly "giving away the store". I'll take that system any day over a system where the person who injured me gets to say what, if anything, my case is worth.
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Should the person who is injured by a physician receive a larger award than the person who has exactly the same disability as someone who is injured in an automobile accident? Right now, the doc will pay more, because he buys higher limits of coverage. Would you be willing to pay more for automobile insurance so victims who are killed or maimed in accidents can get higher awards?
The amount of insurance someone has is irrelevant to the amount of injury someone suffers. If you are afraid that someone injuring you will have inadequate limits of coverage there is a solution. Buy underinsured motorist coverage from your auto insurer. Its cheap and readily available if you ask.
Here's another fact that ought to be of paramount importance in this debate:
1. There's a huge amount of medical malpractice that causes injury to patients and most never results in a lawsuit or even a claim for damages.
Most people really don't want to sue a doctor and will only do so as a last resort. Its the high cost of medical care that drives most people to sue. Its not that medical malpractice is causing high medical care costs as you falsely try to claim.
Last edited by markg91359; 10-11-2012 at 09:00 AM..
See post # 44 in this thread. Even including the costs above salaries, nurses only account for about 5% of health care costs.
The whole healthcare system can be broken up into 5% of this or 10% of that. Few single items will amount to more than that percentage of spending. The reality is that people earning $90,000 a year are much better paid than the average worker in this country is. Ultimately, people earning $30,000 to $40,000 a year are going to have trouble paying for care rendered by people earning $90,000 - $400,000 ( a highly paid specialist physician). You can crunch the numbers all you want. You can reduce hospital visits. You can use the mechanism of risk spreading, or health insurance. The basic problem is that some groups are simply being priced out of the health care market. The only solution is to deliver cheaper, more inexpensive care.
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