To upgrade or not to upgrade
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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.
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the name of the drug is Rimso
another name is DMSO -
@Dashrender said:
the name of the drug is Rimso
another name is DMSOYou pay approx.
$78.95Coverage info not available, thats straight up for 50 pills of RIMSO-50 500MG/G INJ
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@Dashrender said:
the name of the drug is Rimso
another name is DMSOWhoops, there it is as a generic, I'm not sure what the quantity is as 250 units is not descriptive. $7.19 after discount.
Edit: screen caps removed as I felt weird posting them.
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@MattSpeller said:
@Dashrender said:
the name of the drug is Rimso
another name is DMSOWhoops, there it is as a generic, I'm not sure what the quantity is as 250 units is not descriptive. $7.19 after discount.
Edit: screen caps removed as I felt weird posting them.
Where is that?
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@Dashrender said:
@MattSpeller said:
@Dashrender said:
the name of the drug is Rimso
another name is DMSOWhoops, there it is as a generic, I'm not sure what the quantity is as 250 units is not descriptive. $7.19 after discount.
Edit: screen caps removed as I felt weird posting them.
Where is that?
Not sure what you're referring to - the website is my health coverage from work showing what I'd pay for OTC/perscription meds.
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@MattSpeller said:
Whoops, there it is as a generic
Only thing that should exist, really. The idea of brand name chemicals is problematic to begin with.
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This whole problem is because of the drug companies and their demand for profit.
The drug came out and the drug company said - it's $600... Medicare says OK we'll pay $600 for say... 10 years...
during that 10 years Medicare discovers that the company only pays like $30 to make the product (I'm inventing numbers here)... so after the 10 years.. Medicare says enough is enough - drug company you've made enough money on this product we will now only pay $200. Doctors who don't want to lose $400 on this medicine stop prescribing it. after some undetermined amount of time, the drug company goes.. uh hey, why isn't anyone buying rimso anymore? OHHH because medicare is only paying $200 - ok we'll lower our price to $180 - then sales start again. etc etc over time until the consumer is probably paying only 5% over cost or something - think $5 generics.But what's worse (or at least just as bad) is when the drug company can change something stupid like the propellant in a drug and start the whole process all over again.
This happened to Alupent inhalers. They had to move away from CFC propellants. Before the move, the drug was $5 an inhaler, now it's at the top price rank again - I think I pay full price at $55 a unit.
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@Dashrender said:
Medicare discovers that the company only pays like $30 to make the product
Does that include the millions or even billions you have to pay for FDA bribes (I mean trials)?
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@Dashrender said:
This whole problem is because of the drug companies and their demand for profit.
The drug came out and the drug company said - it's $600... Medicare says OK we'll pay $600 for say... 10 years...
during that 10 years Medicare discovers that the company only pays like $30 to make the product (I'm inventing numbers here)... so after the 10 years.. Medicare says enough is enough - drug company you've made enough money on this product we will now only pay $200. Doctors who don't want to lose $400 on this medicine stop prescribing it. after some undetermined amount of time, the drug company goes.. uh hey, why isn't anyone buying rimso anymore? OHHH because medicare is only paying $200 - ok we'll lower our price to $180 - then sales start again. etc etc over time until the consumer is probably paying only 5% over cost or something - think $5 generics.But what's worse (or at least just as bad) is when the drug company can change something stupid like the propellant in a drug and start the whole process all over again.
This happened to Alupent inhalers. They had to move away from CFC propellants. Before the move, the drug was $5 an inhaler, now it's at the top price rank again - I think I pay full price at $55 a unit.
Yeah my inhaler went from $40 to $460
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@johnhooks said:
@Dashrender said:
Medicare discovers that the company only pays like $30 to make the product
Does that include the millions or even billions you have to pay for FDA bribes (I mean trials)?
You mean more doctors who just line their own pockets?
