To upgrade or not to upgrade
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@Dashrender said:
We have drugs that we are now refusing to offer to patients because our costs are $600, but the medicare re-reimbursement is only $200, and we can't get the rest of the difference made up by the patient. So instead we simply refuse to sell it.
That part is, more or less, as it should be from the doctor's side. The same should go for the X-Rays. If the insurance doesn't cover it, punish those with insurance and let them sue the insurer, don't punish the poorest for someone else's inability to pay.
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@scottalanmiller said:
@johnhooks said:
If you tell Medicare that the X-Ray is only $50, they're only going to give you $5.
I don't believe that that is true, they have set prices for these things AFAIK.
While Scott is correct that Medicare does set it's own prices, they don't care what we charge (as long as it's the same or more than they are willing to pay).
The higher price is also based up the agreed contracts set with other insurance carriers. BCBS for example might pay $75 for an X-ray instead of $50...
These numbers are just sample numbers, FYI. But it's very common for private practices to be squeezed like this, where hospitals with much more power backing them are able to get more from the Medicare system, etc. The hospitals are trying to squeeze out the private practices... and sadly they are winning. Today there are fewer and fewer private practices, and instead you just see doctors working for mega health systems.
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@johnhooks said:
If that's the case then their base prices are ridiculous. There is no way it can only cost $50 for an X-Ray. First they have to cover the cost of the machine, which of course over time is less, but that's assuming you have patients that are going to use it. Second is the time to pay a nurse to give the X-Ray and a doctor to go over it. There is no way that is only worth $50.
I guarantee outside of the US it is a fraction of that cost. We are getting an sonogram on Monday full price, paying in cash, so will let you know what it costs here. That should provide a decent baseline idea since we get a level of care I've seen no doctor in the US provide. And these are ER prices, not clinic prices. So no sugarcoating.
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@scottalanmiller said:
@johnhooks said:
If that's the case then their base prices are ridiculous. There is no way it can only cost $50 for an X-Ray. First they have to cover the cost of the machine, which of course over time is less, but that's assuming you have patients that are going to use it. Second is the time to pay a nurse to give the X-Ray and a doctor to go over it. There is no way that is only worth $50.
I guarantee outside of the US it is a fraction of that cost. We are getting an sonogram on Monday full price, paying in cash, so will let you know what it costs here. That should provide a decent baseline idea since we get a level of care I've seen no doctor in the US provide. And these are ER prices, not clinic prices. So no sugarcoating.
That may be what it is outside of the US. But, you're not taking into account insurance liabilities, wage restrictions, unions, etc. All things that cost a lot of money that are outside of the doctors office's ability to control
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@scottalanmiller said:
@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
The reality is, at least in my clinic, that we make agreements with the uninsured and give them medicare rate, and often just dismiss the dept altogether.
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@Dashrender said:
These numbers are just sample numbers, FYI. But it's very common for private practices to be squeezed like this, where hospitals with much more power backing them are able to get more from the Medicare system, etc. The hospitals are trying to squeeze out the private practices... and sadly they are winning. Today there are fewer and fewer private practices, and instead you just see doctors working for mega health systems.
If the doctors are using that as an excuse to squeeze the patients, though, I feel no pity. If the cost of services are non-viable, then we'd see doctors poor, but we don't. We still see private practices throwing money away like it grows on trees and doctors with competence levels that we'd never hire in IT running those practices. So I have a hard time believing that they are being squeezed that much. There is such unbelievable margin in many shops to save money and so often doctors don't care - that's not someone being squeezed, it's someone making excuses.
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@Dashrender said:
@scottalanmiller said:
@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
The reality is, at least in my clinic, that we make agreements with the uninsured and give them medicare rate, and often just dismiss the dept altogether.
The local hospital here will give you reductions based on your income. I think a lot of places do this.
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@scottalanmiller said:
@johnhooks said:
If that's the case then their base prices are ridiculous. There is no way it can only cost $50 for an X-Ray. First they have to cover the cost of the machine, which of course over time is less, but that's assuming you have patients that are going to use it. Second is the time to pay a nurse to give the X-Ray and a doctor to go over it. There is no way that is only worth $50.
I guarantee outside of the US it is a fraction of that cost. We are getting an sonogram on Monday full price, paying in cash, so will let you know what it costs here. That should provide a decent baseline idea since we get a level of care I've seen no doctor in the US provide. And these are ER prices, not clinic prices. So no sugarcoating.
There's probably no robbing Peter to pay Paul there either - so everything can exist at it's actual cost.
I agree it's a huge shit bag here in the US.
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@johnhooks said:
That may be what it is outside of the US. But, you're not taking into account insurance liabilities, wage restrictions, unions, etc. All things that cost a lot of money that are outside of the doctors office's ability to control
If you are in a union, your costs are your own fault and should never be passed to the customer. If your staff had to join a union because you sucked that much and it raised their income, same thing. Doctor's offices control a lot of that stuff. Not insurance problems, but those often are caused by doctors screwing up. Not always, I understand, and often it was other doctors. But that became an issue not completely because America is a litigious society.
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@johnhooks said:
@Dashrender said:
@scottalanmiller said:
@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
The reality is, at least in my clinic, that we make agreements with the uninsured and give them medicare rate, and often just dismiss the dept altogether.
The local hospital here will give you reductions based on your income. I think a lot of places do this.
It's often negotiated and done under duress. Some will, some will squeeze you. Some will break the law to extort. It's all random. It's great that some go out of their way to solve problems, I've never seen this happen in real life. What I have seen is intentional misfiling of insurance forms so that they could extort higher rates from people who had already paid for the service and have no option but to pay again at an inflated rate.
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@scottalanmiller said:
If you are in a union, your costs are your own fault and should never be passed to the customer.
That depends 100% on what state you're in. If you're in a non right to work state you have no control over whether your employees form a union.
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@scottalanmiller said:
@johnhooks said:
@Dashrender said:
@scottalanmiller said:
@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
The reality is, at least in my clinic, that we make agreements with the uninsured and give them medicare rate, and often just dismiss the dept altogether.
The local hospital here will give you reductions based on your income. I think a lot of places do this.
It's often negotiated and done under duress. Some will, some will squeeze you. Some will break the law to extort. It's all random. It's great that some go out of their way to solve problems, I've never seen this happen in real life. What I have seen is intentional misfiling of insurance forms so that they could extort higher rates from people who had already paid for the service and have no option but to pay again at an inflated rate.
We used it and we didn't get squeezed at all. It was fine.
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@scottalanmiller said:
@Dashrender said:
These numbers are just sample numbers, FYI. But it's very common for private practices to be squeezed like this, where hospitals with much more power backing them are able to get more from the Medicare system, etc. The hospitals are trying to squeeze out the private practices... and sadly they are winning. Today there are fewer and fewer private practices, and instead you just see doctors working for mega health systems.
If the doctors are using that as an excuse to squeeze the patients, though, I feel no pity. If the cost of services are non-viable, then we'd see doctors poor, but we don't. We still see private practices throwing money away like it grows on trees and doctors with competence levels that we'd never hire in IT running those practices. So I have a hard time believing that they are being squeezed that much. There is such unbelievable margin in many shops to save money and so often doctors don't care - that's not someone being squeezed, it's someone making excuses.
Are you talking about private practices who serve the wealthy? then sure you're right - and that's definitely the case in hospital and health systems - but most GPs in the midwest are lucky if they clear $100K/yr.
I'm in a specialty office. These guys do both clinical and surgical work, that's why they make $300K roughly a year - otherwise, no chance.
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Ok back to the OP.... Keep XP not worth upgrading if it is isolated.
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@Dashrender said:
I agree it's a huge shit bag here in the US.
The problem with the US system is that it's not necessary. Every person who works in the system does so by choice. Doctors don't just get chosen to be in it, they put in huge money to guarantee their slot in the system and to make their money based on that system. It's not a light decision, they invest a decade of their lives into it. So any doctor in the system that is leveraging it isn't stuck with it, they chose it. They could have done some other field if they had wanted to.
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@Dashrender said:
We have drugs that we are now refusing to offer to patients because our costs are $600, but the medicare re-reimbursement is only $200, and we can't get the rest of the difference made up by the patient. So instead we simply refuse to sell it.
For shits and giggles I logged into my drug coverage calculator. Give me the name of that stuff
Sample: 20mg Lipitor
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@Dashrender said:
Are you talking about private practices who serve the wealthy? then sure you're right - and that's definitely the case in hospital and health systems - but most GPs in the midwest are lucky if they clear $100K/yr.
The office or the doctor barely clears $100K? I've seen lots of doctors who end up with low take homes, but often because they throw it away running a business into the ground.
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@scottalanmiller said:
@johnhooks said:
@Dashrender said:
@scottalanmiller said:
@Dashrender said:
the argument that I hear is that we lose money at the $50 per study we get paid by Medicare. So we have to get more money from the other side to cover the losses by Medicare.
Isn't that yet another degree of worse? The rich people with their insurance manage to get the doctors to give them services at a loss so the poor who can't afford insurance have to not only pay for themselves, and pay for the doctor's Ferrari, but then pay for the rich people with some level of insurance on top of it all! It's like mocking those most vulnerable for being so vulnerable.
The reality is, at least in my clinic, that we make agreements with the uninsured and give them medicare rate, and often just dismiss the dept altogether.
The local hospital here will give you reductions based on your income. I think a lot of places do this.
It's often negotiated and done under duress. Some will, some will squeeze you. Some will break the law to extort. It's all random. It's great that some go out of their way to solve problems, I've never seen this happen in real life. What I have seen is intentional misfiling of insurance forms so that they could extort higher rates from people who had already paid for the service and have no option but to pay again at an inflated rate.
I can say with a straight face we don't do that shit here. and I've been outside of doorways while our billing people have been talking to patients working out reductions and payment plans to help people out.
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@scottalanmiller said:
@Dashrender said:
Are you talking about private practices who serve the wealthy? then sure you're right - and that's definitely the case in hospital and health systems - but most GPs in the midwest are lucky if they clear $100K/yr.
The office or the doctor barely clears $100K? I've seen lots of doctors who end up with low take homes, but often because they throw it away running a business into the ground.
that's a completely different problem - many of them probably need an office manager who knows business. instead it's a failing of education that leads them to believe that they can open a small shop and only worry about the medicine side of the house, and the business side just crumbles.
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@Dashrender said:
that's a completely different problem - many of them probably need an office manager who knows business. instead it's a failing of education that leads them to believe that they can open a small shop and only worry about the medicine side of the house, and the business side just crumbles.
It's a "different" problem. But if a doctor can drive a business into the ground and still take home $100K, he's actually earning far more. The potential earnings of the business are his real earnings, not the $100K. That many choose to throw it away in that way instead of taking it home in a paycheck is purely their own prerogative and there is nothing technically wrong with that. But it does mean that we are paying doctors far too much that so many consider burning money a fun game. That's a level of rich that no one involved in healthcare should be.
