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Well in healthcare news, some hospitals are screwing us


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3 minutes ago, eatcorn said:

I'm not sure I understand what you're saying.

Yes, the attempted fix did not solve all of the issues. How does that then become the cause of the issues themselves?

Things I never said for $500 Alex.

I am saying it is not a coincidence that when our government raids American taxpayers to give money to a major industry they don't do anything to address the cost of services

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2 minutes ago, Dago 3.0 said:

Things I never said for $500 Alex.

I am saying it is not a coincidence that when our government raids American taxpayers to give money to a major industry they don't do anything to address the cost of services

What can the government do to control costs incurred by private businesses?

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1 minute ago, Dago 3.0 said:

Things I never said for $500 Alex.

I am saying it is not a coincidence that when our government raids American taxpayers to give money to a major industry they don't do anything to address the cost of services

WTF are you talking about? One of the major initiatives in the industry right now revolves around cost-cutting. It's why the ACA prioritized preventative medicine (it's way cheaper to treat something before it becomes catastrophic) and made insurance mandatory. When you have more people on insurance, they're more likely to use preventative medicine and not use the most expensive part in healthcare, the emergency room.

The costs haven't gone down yet but it's a big reason why the rate of increase has slowed dramatically since the ACA came into play.

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6 minutes ago, eatcorn said:

What can the government do to control costs incurred by private businesses?

He used the higher education example earlier so I kinda get what he's saying. He's saying that because the government subsidizes loans, there's no incentive for colleges to keep their costs down because they're going to get their money anyway.

What he doesn't realize is that the government doesn't subsidize healthcare like college and healthcare costs go up completely independent of what the government does. In fact the government payers, Medicare and Medicaid, are paying rates which are oftentimes below what it cost to provide services and hospitals run at a loss when they rely heavily on them. Trust me, I just came out of a meeting a few weeks back about how we need to open clinics in places less heavily dependent on Medicare to make up for our clinics in Medicare-heavy areas.

Like I said, this guy truly does not understand what he's talking about. He's talking out of his *** in platitudes and because he's so sure of himself, he won't listen to an actual expert. Until he educates himself, he's not really worth engaging.

Edited by bdog 29
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8 minutes ago, bdog 29 said:

He used the higher education example earlier so I kinda get what he's saying. He's saying that because the government subsidizes loans, there's no incentive for colleges to keep their costs down because they're going to get their money anyway.

What he doesn't realize is that the government doesn't subsidize healthcare like college and healthcare costs go up completely independent of what the government does. In fact the government payers, Medicare and Medicaid, are paying rates which are oftentimes below what it cost to provide services and hospitals run at a loss when they rely heavily on them. Trust me, I just came out of a meeting a few weeks back about how we need to open clinics in places less heavily dependent on Medicare to make up for our clinics in Medicare-heavy areas.

Like I said, this guy truly does not understand what he's talking about. He's talking out of his *** in platitudes and because he's so sure of himself, he won't listen to an actual expert. Until he educates himself, he's not really worth engaging.

unless you can quote me actual cost of services instead of what is on the bill, you are talking out your ***

if my cost for providing a service is $500 and I bill people without insurance $3000, I am not losing money when insurance only gives me $1700. I can claim I am and gullible people will believe it, but that ain't the case

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2 minutes ago, Dago 3.0 said:

unless you can quote me actual cost of services instead of what is on the bill, you are talking out your ***

if my cost for providing a service is $500 and I bill people without insurance $3000, I am not losing money when insurance only gives me $1700. I can claim I am and gullible people will believe it, but that ain't the case

Ok, then please explain the string of hospitals going bankrupt or having to merge with other hospitals just to survive. And also list me another private business that's required to show you their costs? An itemized bill, like the example you gave in your mechanic example doesn't list costs, just what they're charging you. A hospital could do the same but because of complexities with procedure codes and DRGs, they can't tell you how much this stuff actually costs until they submit the bill to the insurance company.

I can understand all of these arguments but you have to realize that healthcare is just more complicated than your average service industry. Going back to your mechanic example again, you could be going in for a busted transmission but they could find out the oil line is leaking as well. They could come to you, tell you, and let you decide what you want to do. With healthcare, they could go in for an appendix and find out you have cancer. Do you want them to just take out the appendix, wake you up, tell you and let you decide whether you want to get the cancer removed now? Wouldn't you be pissed you have to have another surgery? Or would you be more pissed they took out the cancer without your consent because now your bill will be more?

Healthcare isn't purely a profit-maximizing business. There are ethical dilemmas that go into it in addition to the financial costs (hence why we still have clinics in areas that are Medicare and Medicaid heavy though they lose us money). You handwave all of these issues away without even acting like you care to think about them deeper.

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36 minutes ago, bdog 29 said:

Ok, then please explain the string of hospitals going bankrupt or having to merge with other hospitals just to survive. And also list me another private business that's required to show you their costs? An itemized bill, like the example you gave in your mechanic example doesn't list costs, just what they're charging you. A hospital could do the same but because of complexities with procedure codes and DRGs, they can't tell you how much this stuff actually costs until they submit the bill to the insurance company.

I can understand all of these arguments but you have to realize that healthcare is just more complicated than your average service industry. Going back to your mechanic example again, you could be going in for a busted transmission but they could find out the oil line is leaking as well. They could come to you, tell you, and let you decide what you want to do. With healthcare, they could go in for an appendix and find out you have cancer. Do you want them to just take out the appendix, wake you up, tell you and let you decide whether you want to get the cancer removed now? Wouldn't you be pissed you have to have another surgery? Or would you be more pissed they took out the cancer without your consent because now your bill will be more?

Healthcare isn't purely a profit-maximizing business. There are ethical dilemmas that go into it in addition to the financial costs (hence why we still have clinics in areas that are Medicare and Medicaid heavy though they lose us money). You handwave all of these issues away without even acting like you care to think about them deeper.

1) no I can't and neither can you. 

2) actually most reputable mechanics use a repair guide. whether you agree with it or not, it does at least provide transparency and give the consumer information about their service. I agree you don't exactly know their cost, but then they aren't getting subsidized by the American taxpayer

3) this has nothing to do with the lack of transparency or the fact that the medical industrial complex goes to great lengths to hide the actual cost of their services

4) again, you cannot prove they are actually losing money by using medicare and medicaid. you are strictly going off what they would bill for someone without insurance. 

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6 minutes ago, WhenFalconsWin said:

That's the plan, Stan.

No it's not right now.  They are going to make it worse.  Well if it is so great why not debate it and not pass it in the dark?  Or is it okay because R?  You can complain about Dems, but it took over a year to craft the final legislation.

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Just now, Dago 3.0 said:

1) no I can't and neither can you. 

2) actually most reputable mechanics use a repair guide. whether you agree with it or not, it does at least provide transparency and give the consumer information about their service. I agree you don't exactly know their cost, but then they aren't getting subsidized by the American taxpayer

3) this has nothing to do with the lack of transparency or the fact that the medical industrial complex goes to great lengths to hide the actual cost of their services

4) again, you cannot prove they are actually losing money by using medicare and medicaid. you are strictly going off what they would bill for someone without insurance. 

1) Yes I can. It's because healthcare costs are rising so much that margins are decreasing to the point where the only way to make profit is through volume. Because of this, smaller clinics are either partnering with larger systems to drive volume to them or being bought out.

2) Healthcare is way less standardized than auto repair though. I guess you could publish expected billings for these procedures but someone's going to get pissed when it turns out they have to pay twice as much as they expected because they had some unknown condition that made their procedure way more complicated.

3) lol at "medical industrial complex". You really think you've unearthed some type of conspiracy.

4) I'm a regular part of our finance meetings and a point that is brought up over and over again is how we need to improve payer mix. You always want more private payers than public because public payers pay so little. It's the same reason why places in rural areas have so few clinics and hospitals. They're not profitable because they get most of their money from public payers, usually Medicaid.

I know this won't resonate with you because you asked the questions under the assumption that everyone is as ignorant as you about this stuff. But there are people who spend countless hours trying to  But hopefully other people who may be wondering the same things will see it and get something from it. It's obvious you refuse to learn about this because you want to be stuck in your ideas.

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1 hour ago, eatcorn said:

What can the government do to control costs incurred by private businesses?

They could have approved Bernie Sanders bill to import Canadian drugs but too many hands in the cookie jar wouldn't allow that.  Increased competition would force US companies to compete (kind of like what Walmart did for retail) or get out...

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14 minutes ago, lostone said:

No it's not right now.  They are going to make it worse.  Well if it is so great why not debate it and not pass it in the dark?  Or is it okay because R?  You can complain about Dems, but it took over a year to craft the final legislation.

You haven't even seen what the senate has come up with.  So you're saying their plan is not to make something better than the ACA?  C'Mon man!!!

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2 minutes ago, capologist said:

They could have approved Bernie Sanders bill to import Canadian drugs but too many hands in the cookie jar wouldn't allow that.  Increased competition would force US companies to compete (kind of like what Walmart did for retail) or get out...

Pharmas a bit difficult because it is very expensive to come up with a new drug and you only have so long to get as much money as you can before your patents run out and everyone can make a generic version of your drug.

The main argument I've heard against coming down on pharma's profits too much is that it'll stifle innovation because the risk-reward won't be worth it. You already see this in antibiotics (a new class hasn't been discovered for a few decades now I think) and it's part of the reason we're hurtling into the age of antibiotic resistance.

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13 minutes ago, bdog 29 said:

1) Yes I can. It's because healthcare costs are rising so much that margins are decreasing to the point where the only way to make profit is through volume. Because of this, smaller clinics are either partnering with larger systems to drive volume to them or being bought out.

2) Healthcare is way less standardized than auto repair though. I guess you could publish expected billings for these procedures but someone's going to get pissed when it turns out they have to pay twice as much as they expected because they had some unknown condition that made their procedure way more complicated.

3) lol at "medical industrial complex". You really think you've unearthed some type of conspiracy.

4) I'm a regular part of our finance meetings and a point that is brought up over and over again is how we need to improve payer mix. You always want more private payers than public because public payers pay so little. It's the same reason why places in rural areas have so few clinics and hospitals. They're not profitable because they get most of their money from public payers, usually Medicaid.

I know this won't resonate with you because you asked the questions under the assumption that everyone is as ignorant as you about this stuff. But there are people who spend countless hours trying to  But hopefully other people who may be wondering the same things will see it and get something from it. It's obvious you refuse to learn about this because you want to be stuck in your ideas.

you know what isn't complex? calling for us to adopt the same healthcare model (or similar) to other countries and ignoring the fact that it costs us 2.5x more per person than other developed countries is idiocy. 

you can talk about your little circle jerks all you want but you have yet to address actual cost. 

but since I am obviously ignorant, I guess these people are too

https://www.theatlantic.com/health/archive/2015/06/hospitals-that-charge-1000-more-than-they-should/395099/

http://www.governing.com/topics/health-human-services/what-hospitals-overcharge.html

https://www.washingtonpost.com/news/to-your-health/wp/2016/10/20/despite-being-shamed-for-overcharging-patients-hospitals-raised-their-prices-again/?utm_term=.198d5ba6744a

http://time.com/money/4541049/hospitals-prices-overcharging-patients-report/

https://www.forbes.com/sites/rickungar/2013/05/08/the-great-american-hospital-pricing-scam-exposed-we-now-know-why-healthcare-costs-are-so-artificially-high/#2b99b15b3bff

I could go on and on but I know this won't resonate with you because you think you are the only one who knows anything on the subject and the rest of these researchers and publications are just idiots like me

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1 minute ago, Dago 3.0 said:

you know what isn't complex? calling for us to adopt the same healthcare model (or similar) to other countries and ignoring the fact that it costs us 2.5x more per person than other developed countries is idiocy. 

you can talk about your little circle jerks all you want but you have yet to address actual cost. 

but since I am obviously ignorant, I guess these people are too

https://www.theatlantic.com/health/archive/2015/06/hospitals-that-charge-1000-more-than-they-should/395099/

http://www.governing.com/topics/health-human-services/what-hospitals-overcharge.html

https://www.washingtonpost.com/news/to-your-health/wp/2016/10/20/despite-being-shamed-for-overcharging-patients-hospitals-raised-their-prices-again/?utm_term=.198d5ba6744a

http://time.com/money/4541049/hospitals-prices-overcharging-patients-report/

https://www.forbes.com/sites/rickungar/2013/05/08/the-great-american-hospital-pricing-scam-exposed-we-now-know-why-healthcare-costs-are-so-artificially-high/#2b99b15b3bff

I could go on and on but I know this won't resonate with you because you think you are the only one who knows anything on the subject and the rest of these researchers and publications are just idiots like me

When you consider that the contracts with insurance companies often say they'll pay X percentage of a total bill, maybe then you'll understand why hospitals charge as much as they do. They know they're not going to get the full amount of money so they charge what they do assuming they'll only get that percentage. The only issue here is for uninsured people who think they have to actually pay that amount (truthfully if you say you'll be around half, they'll take it) and people who can't handle seeing such large numbers.

It's a stupid way of charging and paying for things and I was shocked to find this out how we do things in America but I wouldn't use the hospital sticker price as any indication of what hospitals actually make. Once again the system is flawed but you have to understand it before you try to remedy it.

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1 minute ago, bdog 29 said:

When you consider that the contracts with insurance companies often say they'll pay X percentage of a total bill, maybe then you'll understand why hospitals charge as much as they do. They know they're not going to get the full amount of money so they charge what they do assuming they'll only get that percentage. The only issue here is for uninsured people who think they have to actually pay that amount (truthfully if you say you'll be around half, they'll take it) and people who can't handle seeing such large numbers.

It's a stupid way of charging and paying for things and I was shocked to find this out how we do things in America but I wouldn't use the hospital sticker price as any indication of what hospitals actually make. Once again the system is flawed but you have to understand it before you try to remedy it.

so what they do is enter into an agreement with an insurance company to accept a percentage of their normal billing price, then go up on their normal billing price so they are still making the money they want from the insurance companies while screwing those without insurance even harder. 

and you were sitting here defending that

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19 minutes ago, Dago 3.0 said:

so what they do is enter into an agreement with an insurance company to accept a percentage of their normal billing price, then go up on their normal billing price so they are still making the money they want from the insurance companies while screwing those without insurance even harder. 

and you were sitting here defending that

Yup, that's exactly what they do. But I think it's a stretch to say they screw those without insurance because they often settle with those people or write off the amount anyway.

And I think you're missing the key point here. They have to increase those prices because margins are so thin a lot of them are barely getting by (hence the bankruptcies and mergers I mentioned before). I think you see these high prices and assume their profit margins are just as high but you have to remember that what they pay for clinicians and facilities are astronomically high too. Hospitals are quite often not profitable.

Edited by bdog 29
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14 minutes ago, bdog 29 said:

Yup, that's exactly what they do. But I think it's a stretch to say they screw those without insurance because they often settle with those people or write off the amount anyway.

And I think you're missing the key point here. They have to increase those prices because margins are so thin a lot of them are barely getting by (hence the bankruptcies and mergers I mentioned before). I think you see these high prices and assume their profit margins are just as high but you have to remember that what they pay for clinicians and facilities are astronomically high too. Hospitals are quite often not profitable.

there is far more to a business being profitable. you said I am being simplistic, but just saying that the prices have to be that way to be profitable and even then many hospitals aren't ignores things like inefficiency and bloated bureaucracy

furthermore, a complete lack of ethics and transparency in handling billing only adds to the problem. 

I am not against some sort of universal healthcare. What I want is some sort of accountability which is impossible without knowing cost and the medical industry goes to great lengths to obfuscate that. 

 

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To set the record straight, I was the one that made the mechanic analogy, not Dago. And thanks for finally bringing it back up. I was worried you were more interested in arguing than discussing.

I'll rebut the points you made. Your reference to decisions made during surgery don't match the narrative. That's akin to asking an emergency services worker for a body shop estimate prior to using the jaws of life to free you after an accident. I'm asking for better explanation of costs and procedures in non-emergency situations. If certain treatments are legitimately optional, let the patient decide those based on cost. Far too often (especially in the ER), those things are done without explanation. The patient is then left to foot the bill, as you put it, to help make up for other patients.

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On 6/16/2017 at 9:37 AM, bdog 29 said:

If this study really used the Medicare allowable as their benchmark, it's already extremely flawed. The Medicare allowable is the absolute floor in what a hospital can accept for reimbursements and is often less than what it actually costs to even provide care. If you expect most hospitals to run based on Medicare allowables, the vast majority would be bankrupt within a year.

On top of that because of EMTALA hospitals have to provide care for everyone who shows up to an emergency room. Doesn't matter if you got shot or you think this cold you have is getting worse. If you show up to an emergency room, they have to take care of you. As I'm sure you can imagine doctors, nurses, and other clinicians who specialize in emergency room care are more expensive than your neighborhood doc so obviously services in the ER will cost more to make up for that. On top of that, since the hospital legally can't turn you away, they have assume a certain percentage of the people who show up in the ER will not be able to pay a cent towards the care they got. They make up for this by charging everyone else more on their bill to help subsidize that. Even with all this, most ERs run in the red and are subsidized by the larger hospital budget.

I say all this to say that hospital finance is complicated and messy and this study is extremely flawed for using the Medicare allowable as their benchmark and not going into the nuances of why hospitals charge as much as they do. There's a reason why most people in healthcare finance believe single payer would be the best option and as people become more aware of how stupid and complicated this all is, I think they'll be more for it.

Source: MPH in Healthcare Management, been working in healthcare finance and rev cycle at major ATL hospitals for a few years now.

Truth 

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