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Open thread May 19, 2017

Dan Crawford | May 19, 2017 11:43 am

Tags: open thread Comments (4) | Digg Facebook Twitter |
4 Comments
  • Denis Drew says:
    May 19, 2017 at 5:33 pm

    http://www.kevinmd.com/blog/2017/05/time-physicians-fight-back-now.html

    Some doctors thinking of fighting back — my usual suggestion tree:

    Poster: “I think the answer is to better organize — even to form unions (though they are legal for physicians only in certain circumstances) — to … ”
    …
    Me: Theoretically — my theory anyway, now that I understand that you plural are talking about individual doctors not being allowed under anti-monopoly law to combine to set a price — the doctors counter-argument could be that their monopoly fairly balances off against the large organization’s monopsony. It’s not like the old railroads charging all the traffic will bear — what we should always be looking for is a fair balance, which in this case works when doctors combine. Not that the courts are necessarily going to recognize a balance if they trip over it. Sounds like a good approach to court or justification for new legislation. Best part of it is actually true.

  • Denis Drew says:
    May 20, 2017 at 10:10 am

    http://www.kevinmd.com/blog/2016/12/american-doctor-experiences-uk-emergency-care-firsthand.html

    An American doctor experiences UK emergency care firsthand
    Jennifer Gunter, MD

    “My cousin was at the hospital for four hours, but over an hour was an unavoidable wait for fracture clinic and about 30 minutes of transport back and forth between the ER, urgent care and fracture clinic. To receive this care, all my cousin had to do was provide her name and birthdate. No copayments, no preauthorizations, no concerns about the radiologist or orthopedic surgeon being out of network. The nursing triage was wonderful and actually doing nursing (I hate seeing nurses relegated to charting). The nurse practitioner clearly knew what she was talking about and had reviewed the films with the radiologist. The surgeon only did the part of my cousin’s care that needed a specialist. It was a great use of resources.”

    “When I think of copayments [state side], I think of a 60-year-old woman with breast cancer three years post-surgery and chemotherapy now in remission. She developed a cough and a fever so received a chest X-ray to look for pneumonia. The radiologist found something not quite right, a spot that was especially concerning given her breast cancer history. She needed a CT scan to see if this is a bit of scarring or if her cancer has metastasized to her lungs. When I asked her why she hasn’t yet had the CT scan she told me she couldn’t afford her $100 copayment. It will take her two months to save the $100 so she can get the CT scan to find out if her cancer has returned. She looked at me in the eyes for just a moment and then a mixture of embarrassment and fear that my eyes might tell her what she doesn’t want to know caused her to look away. And what if her CT scan is equivocal and she needs $100 (or more) for the copayment for a lung biopsy? If that’s not a circle of hell, I don’t know what it. Do you want to know what’s worse? I’ve heard a variation of this story more than once.”

    • run75441 says:
      May 20, 2017 at 2:47 pm

      Dennis:

      Who has not heard a variation of that story. If you read Dan’s post stealing from NC by Lambert. Here is what I will tell you about the three examples of healthcare cited in Dan’s post as taken from NC:

      “Lydia Holt and her husband tuck money into these envelopes with each paycheck to whittle away at what they owe. They both earn about $10 an hour and, with two kids, there are usually some they can’t fill.” This is ~175% FPL. Kaiser Healthcare Calculator says:

      – Estimated financial help:  $555 per month ($6,654 per year)  as a premium tax credit. This covers 73% of the monthly costs.               
      – Your cost for a silver plan:  $203 per month ($2,439 per year)  in premiums (which equals 5.54% of your household income).       
      – The most you have to pay for a silver plan: 5.54% of income for the second-lowest cost silver plan                       
      – Without financial help, your silver plan would cost: $758 per month ($9,094 per year)
      They also qualify for CSR to cover out of pocket expenses;  out-of-pocket limit for a silver plan can be no more than $4,700 in 2017.
      If they bump up to a higher level Silver Plan, they would not incur any more expense and would perhaps have lower out of pocket cost.

      The Kramer example does not have enough info to really judge; but one woman with 5 kids unless she is pulling down well over $100,000 is going to be getting some type of stipend. And the couple paid a $2000 and were probably making $100,000. No subsidy and a silver plan would be ~$463/month. They were almost half way there with the $2000.

      The final story is similar to the first story. If the woman is by herself, a Silver plan would be $94/month.  Out-of-pocket limit for a silver plan can be no more than $2,350. Maybe she can not afford $94 a month  or $47 for a Bronze plan. ACA and insurance are not the issues. Healthcare is the issue and the way it is delivered.  

      If this is the basis for finding fault, it is false information the same as when ACA first came out and a plethora of stories emerged claiming this and that. Is there a problem? I do not know and there is too little to judge what the problem can be with these examples. And this is forming public opinion and allowed to do so without close examination of the facts.

      Two months to save $100 can be true; but, where is the rest of the detail? The average ER visit is $2,000 for those without insurance. Usually the person treated pays 1/3, gov used to shove in another portion, and the rest is written off. $100 for a lung biopsy, what do you think would happen if this was the only thing preventing treatment?

  • Denis Drew says:
    May 20, 2017 at 11:58 am

    From the first Kevin MD post above:

    Agree with all the comments. I do inpatient rehabilitation and it is ridiculous what Medicare requires us to do in terms of documentation. It adds nothing to patient care and keeps us away from patients’ bedsides and from the therapy gyms. I currently have a White House petition to ask the administration to get rid of requirements for duplicative documentation. We need 100k signatures for an official response, so please take a minute to sign it at: https://petitions.whitehous…
    * * * * * *
    We are worried about distracted drivers. How about distracted doctors?

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