Re: Health care and third payer psychology

On Jun 26, 8:52 pm, VA Beach Hokie <wjlm...@xxxxxxxxx> wrote:
On Jun 26, 6:58 pm, mianderson <clay...@xxxxxxxxxx> wrote:



On Jun 26, 5:14 pm, VA Beach Hokie <wjlm...@xxxxxxxxx> wrote:

On Jun 26, 4:45 pm, VA Beach Hokie <wjlm...@xxxxxxxxx> wrote:

On Jun 26, 1:09 pm, Emperor Wonko the Sane <d...@xxxxxxxxxxxxxxxxxxx>
wrote:

Ralphie posted an article (http://www.newyorker.com/reporting/
2009/06/01/090601fa_fact_gawande) that got me thinking. How much of
the current cost problems in health care are caused by third payer
psychology. For example, doctor is seeing a Medicare patient with
back pain. The doctor thinks "surgery might help him, and he's not
paying for it himself, so let's give it a shot." So the patient gets
an operation that might or might not help him. Would the doctor's
decision be different if he knew the money was coming out of the
patient's pocket? (I'm assuming this is an honest doctor, which I
think the vast majority are.) If that is a big part of the problem,
how do correct it?

Doug

I_know_I'm a net loss to the insurance companies over the last 5 years.

<Hit send too soon>

Three medical needs in the last 5 years have far outstripped what I've
paid in if one places any stock in the bills supposedly paid by
insurance.

Trip 1, emergency room, left side numbness. EKG, CT Scan, IV fluids.
Diagnosis:TIA. Treatment: Aspirin. Cost $4600

Trip 2, ER, gut pain. EKG, XRay, MRI, Upper GI. Diagnosis:
Pancreatitis. Treatment: 3 day liquid diet. Cost $5200

what did your insurance pay for these visits?(because thats the only
value that has meaning in 95% if ed visits since self pay people
almost never pay)?....

Im guessing that for a tia visit where they did the routine **** the
bill was 4-5K but your insurance paid about 1600-1800 or so......which
is not at all unreasonable.

Well, I paid $150 for the TIA visit and $225 for the pancreatitis
visit. Whether the insurance company actually paid the entire
remainder of the bill or some other negotiated rate is beyond my
knowledge.


Ummm...if you have decent insurance their share was probably about
1100 for each visit...give or take a few hundred...next question....



Which really isn't my point or the point of the article. That point
was whether the hospital could/should have determined that my symptoms
were not of something life threatening without performing $10k worth
of tests. Especially in the case of the reflux. A $2k stress test
was, IMO, beyond necessary. (Not to mention a pain in the ass and a
waste of a PDO day)


LMFAO......so you want a physician who has never met you(and Im
guessing based on your 3 visits listed you have some risk factors) to
just assume when you come into the ED that your a GERD pt and send you
on your way without an ekg or enzymes or anything?

God damn you are dumb....that ed physician will see 20 cases like you
every two weeks...if he sends everyone like you home without a basic
workup he will miss 2 per week and when those pts go home with a huge
ass MI he will be sued once per week for seven figures...and he should
be.....

Bottom line: sometimes pts piss me off. People come in(even with
insurance) to the ed with risk factors and fairly vague symptoms(ie
chest pain, bad headache, a little numbness, whatever)....well ***,
what the hell do you expect? The ed physician doesnt know you, you
have risk factors, and you're complaining of vague symptoms that may
or may not be an MI or stroke........he *CANNOT* just pat you on the
back and send you on your way without an MI or stoke workup, and he
shouldn't.....

As for the TIA/aspirin snarky comment- just what in the hell do you
think is the SOC for TIA? The key with a TIA is to dx it(and they
apparently did, although a CT sometimes cant pick it up in that time
period).....

Bottom line#2: pts complain too much, and they also dont know what the
hell they are talking about....

.