Me too. Think about your quality of life and just being a burden to the system and to others. If I can't take care of myself, let's just get this over with.
OT: Healthcare
- Thread starter FormerBully
- Start date
Me too. Think about your quality of life and just being a burden to the system and to others. If I can't take care of myself, let's just get this over with.
Actually, it is almost always fraudulent regardless of system design, if we consider breaking contracts to be fraudulent. Contracts in the US typically prohibit the practice of allowing an insured person to self pay at a lower rate than their insurance contracted rate.
In the near future, will AI greatly reduce administrative costs via billing, scheduling, insurance processing, call centers, documentation and revenue cycle management?
Love this question. Short answer is no, but I’ll provide a long answer when I am back at my computer. Impact on total healthcare cost, the parties using it, and how that translates to patient savings will vary by each of those activities
Bottom line, there's no free lunch, and efficiency matters. Healthcare will always cost money, and someone has to pay for it. Increasing wait times for non-urgent care is a way most countries significantly decrease their expenditures, though the actual wait times are usually massively exaggerated. The efficiency of health care costs in this country is totally off the rocker though. We pay 3x what we should, based on other countries. Most of that difference goes to middlemen not actually providing care.
Here's a stat: 85% of Medicaid funding goes to pay for elder care, even though only 15% of Medicaid enrollees are elderly.
Read the above again. Healthcare costs (yes, the above is not strictly "healthcare") are so ridiculously slanted to the elderly, that there's no way for a "free market" to handle it. The whole perverted system is just there to have ways for the young to cover the costs of the old. The inefficiency is there to enrich the middlemen.
This is going to sound morbid, but the boomers are a huge strain on health care. It’s just an insane amount of people getting old at the same time. And not just what we used to consider old, They are living into their upper 80’s and into their 90’s. It’s not sustainable. Behind them is Gen X. There aren’t near as many of us.
Which is why I find it hilarious when people accuse doctors and the medical field in general for ignoring diseases, etc. either the boomers are naturally invincible or we are doing a pretty good job with this whole medicine thing
Which is why I find it hilarious when people accuse doctors and the medical field in general for ignoring diseases, etc. either the boomers are naturally invincible or we are doing a pretty good job with this whole medicine thing
Asian countries also have a demographic strain on their healthcare system but the costs aren't nearly as pronounced. I think that depression is so rampant in the US people are self medicating in a way that ends up causing some very expensive problems down the road. Also, there's this attitude of "I can do what I want and if something happens to me the health care system can fix me". Obesity and general poor health due to drinking, drug abuse and a sedentary lifestyle (video games, social media, streaming) is clogging our ERs and hospitals with people who don't have to be there.
More detailed answer:
I'm going to start by not even touching AI and instead focusing on payor incentives and fee schedules:
- Medicaid
- Fee schedules are set, but vary by Medicaid provider type. MCOs have some flexibility to go up or down or agree to alternate payment models, but for the most part provider payment is based on the Medicaid fee schedule for whatever provider type they're under.
- Medicare
- Fee schedules are set and vary by geography
- Commercial (Employer + Marketplace; looping in Medicare Advantage too)
- They may have a default fee schedule, but it's negotiable. Larger networks and/or ability to handle needs of special population groups on the provider side can help negotiate better rates.
- Self-pay
If a tech-enable provider (or even a traditional provider) finds some AI use that saves them 10% of operational costs, it's not like they're going to start charging below the fee schedule they have access to. If anything, it may free up cash to let them hire more, spend more to acquire patients, enter new markets, etc. AI efficiencies are likely to help the tech-enabled groups scale and increase their negotiating leverage to increase commercial fee schdules.
There's also going to be a "cost of doing business" component to successful AI uses. As in, the person providing the AI is going to want to get as much as possible eventually. They may underprice for a while to get marketshare, but they will press up the price at some point, especially if providers are heavily relying on the service, have invested in integration, and don't have good alternatives.
For your specific use cases:
- Billing
- Will keep this separate from RCM and focus on coding and patient responsibility. AI already increases upcoding, often through scribe software, and that's a key value prop for those companies when approaching practices.
- I expect AI to play a role in trying to improve collection rates and speed on patient responsibility
- Don't expect either of these uses to decrease costs.
- Scheduling + Call centers
- I'm grouping these because AI is taking on some similar tasks and replacing similar skill leveled employees. There will be some cost savings here, but it's a more complex problem than most realize. I expect the cost savings to be realized by large, tech-enabled providers and for non-tech-enabled providers to pay third parties with generally poor results and ROI. I don't expect this to translate to patient savings.
- Insurance processing + RCM
- Combining these because I see AI playing a role in an escalating battle. As insurance company pressures continue to tighten, they'll have less and less incentive to invest in improving their processing systems. They will be incentivized to put up more barriers to processing (underfunding contract loading staff, slow cred timelines, old systems/software, increasing provider audits/documentation review). Payors may also use it to identify providers to drop. They'll balance all this with litigation risk.
- RCM may use AI to assist with day to day work, finding patterns, etc., but I see the AI value here to come from using software that's making payor pattern observations across tons of providers and having AI use those data to build payor-specific billing rules and adapt them over time as payor patterns change.
- There'll be some efficiency from providers who can take advantage of the AI in RCM, but they'll be combatted by payors trying to pay slower and less. The ones who can't take advantage of these patterns will be at risk. I see this as an evolution of the battle and not something that'll drop costs. It'll likely make it harder on providers, and providers are already struggling with this stuff.
- Documentation
- Assuming you're asking about EHR documentation. There's already and will continue to be some benefit to provider experience with this. It'll vary based on note structures and practice types. I don't expect this to lower costs for patients.
- There'll be some patient value from AI-assisted record access, letters, etc., though I don't expect it to lower costs
Long term, there's hope for cost containment, but it won't be easy. I do expect some improvement in user experience across most parties in healthcare. Just don't see costs going down in the short term. Some healthcare operational costs will drop in certain areas, but I don't see those getting passed on to patients.
One key problem is that health insurance goes way beyond what “insurance” should be. How often do you make a claim on your home insurance, car insurance, or life insurance policies? It’s likely quite rare. Because that’s what “insurance” is. Most of us use health insurance monthly, and many of us weekly. We have a system where we add multiple middle men into the mix for people just going to the doctor because of their yearly physical or because they came down with bronchitis. If health insurance was limited to major surgeries, broken bones, cancer treatment, etc, and health care providers had to truly compete on costs for the rest, we’d all be much better off….except for the people getting it free and paid for by taxpayers.
I hate to post this, but I've seen people call an ambulance with not much more than a hangnail.
"I've got insurance....."
Maybe a slight exaggeration, but not much.
"I've got insurance....."
Maybe a slight exaggeration, but not much.
Appreciate the well thought out post. I was hoping there'd be more meat on the bone for cost savings there. Looks like we'll have to find it elsewhere.
What incentive would drug manufacturers have to lower their prices, if prescriptions weren't covered by insurance?
The only scenario I can think of is that not enough people could afford to pay, so prices would have to come down to even sell enough volume to make it worthwhile.
But I don't believe for a second that eliminating prescriptions from being covered by insurance would make medication affordable as a whole.
Manufacturers will still put profits first to maximize shareholder value, because that is what they are required to do as publicly traded companies. And private ones will continue to prioritize profits because that is what owners want.
There’s potential in some areas, but I think it’ll take time. The direct care delivery has potential, but it’s going to be a regulation slog (understandably). I do expect some self pay services to expand near term
I’m self employed and insurance for my family was outrageous. Couple years ago I changed to an Indemnity Plan. I pay the difference and it’s worked well. We have had one trip to the ER in that time and I pay the hospital monthly for the rest of the bill. Much cheaper than the quotes I was getting and we use GoodRx or Amazon pharmacy and it’s done well for us saving money.
Nobody has mentioned the death of local pharmacies. They're generally much cheaper than the ones that control everything. I'm lucky to have one and pay $5 for meds that cost me $75 at CVS. Eventually everything in this planet will run through just a couple companies regardless of the industry. That's capitalism coming apart from manipulation.
Hang in there until you reach 65. Medicare gets a bad rap but it works. Medicare plus a supplement is the way to go unless you are in great health then maybe an advantage plan. My family has had 3 major medical issues and the only thing we have paid is our deductible (about $280 a year) and our supplement premium which is about $3600 a year for both. We have zero premium on drug coverage and short wait times for service. For you young pups you can choose between having a kick *** military, massive fraud, condom program for Africa or welfare for illegals. Sorry, the country can't afford it all. In fact, we have overspent by 35+ trillion already. Of course, there is that possibility that medicare will be bankrupt before you turn 65. Sorry.
Smart, rich people figure out ways to remain smart and rich by arranging economic outcomes in their favor. That includes lobbying.
This all day every day.
We're all in a losing battle with death. We need to to relearn how to let people go with dignity and as little pain as possible when it's their time.
That's where we are headed right now. That's what high deductibles really are.
There is absolutely a way for the free market to handle it. Politically we choose not to. Old people vote, so they are able to vote themselves money transferred from younger people. Most younger people are sympathetic to it because they think it relieves them of the financial burden of taking care of their parents, which depending on the number of their siblings and their earnings, it probably does. (A family with two siblings making the median wage are going to pay something like $15k a year in SS/medicare total and the median social security payment is $2k per month, but the average social security recipient receives it for 20 years, whereas the average time to pay is more like 40 years; so when you take medicare into account, there is a good chunk beyond taxes essentially paid for with US debt).
We had a different system, and we butchered it in 2010. Don't get me wrong, it was far from perfect then, but it was better than what we have now (if only because it was a singular system). You mentioned the European systems - what we have now is an abomination of a mash-up between our previous system and those systems. It's sad to say, but either of those systems would be better than the mash-up we have now. So, in 2010, we should have either gone all the way to the European systems, or left it alone. People have different opinions on which path would have been better back then, but to keep it from being political (per your request), I'll just say we should have picked one instead of trying to do both. Ultimately, the best system would be no system at all. Everyone pays out of pocket. This would drive down the cost of service significantly by itselt. Maybe have a catastrophic policy for cancer and other bankruptcy inducing conditions, but having a company that pays for regular doctor visits, prescriptions, annual check-ups, etc. is asinine. But the industry's lobbyists have us where we are today.
If I were you, that's what I would look for. The cheapest catastrophic plan available through the marketplace, then pay the rest out of pocket. You would have several thousand dollars to go through before you even hit what you're now spending just on premiums. Additionally, you end up paying a fair amount out of pocket for services anyway. If no one in your family has a major chronic illness, you'll probably be better off. The mandate to have health insurance expired in 2018, so there's no more tax penalty.
So you'd think our morbidity rate would look better in comparison - instead it is so bad in comparison it is rarely discussed by policy makers. They have given up.
- We have the highest rate of chronic disease among high income countries - comparable to Cameroon.
- The highest rate of infant death almost twice as high as the next highest high-income country's infant death rate.
- Also we have, by far and away again, the highest rate of external causes & injuries (overdoses, homicides, and motor vehicle accidents)
- Our life expectancy is less than Cuba's
Easy money for the healthcare industry.
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This getting close to the truth of Obamacare that most dont want to see: that it was intended to prop up the system we had, not fundamentally change it.
Pre-existing conditions was absolutely destroying the system we had, and getting worse every year. Without a fix, socialized medicine would have happened. Obamacare was that fix.
That's Capitalism.
Those with the most capital can continue to buy out those with less if they chose or they can just put them out of business.
Oh, and they get to set the rules.
This is the way.
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If by "there is absolutely a way for the free market to handle it" you mean "get sick and you're screwed" or "make the right pick of ins companies in your 20s so you're protected to 65, otherwise you're screwed", then sure. A free market as we understand it cannot provide coverage for highly variable high dollar events in your 50s and 60s by premiums in your 20s.
Sorry to burst your magical thinking, but free markets dont magically produce good outcomes for non-market goods. They produce profits, sure.
I have an aunt in France who is dealing with breast cancer. It's been an absolute nightmare for a year now. She had to wait almost 5 months after diagnosis to start receiving actual care. And this was for stage 3. They have government provided healthcare. 70% is paid by the state, and this is funded by their payroll taxes. The dirty secret is that most people also end up buying private insurance to cover all the gaps from the public plans. But they're still subject to state calling all the shots because they have the majority stake. It's pretty broken in a lot of places.
I don't necessarily disagree with this, but mostly it reflects a continuation of the status quo, where a stranglehold on supply and subsidies for demand result in a system where there is a ton of effort spent in a zero sum game of insurers using their market power to force providers to jump through more hoops to get paid, but ultimately at the end of the stranglehold on supply means providers have something like cartel negotiating leverage and they will get their pay one way or another. AI being looped into this process means ramping up the arms race and introducing new opportunities for money to be siphoned off by the people/contractors enlisted to push those limits for providers or insurers.
For AI to make a meaningful difference in the costs, regulations are going to have to be loosened to allow AI to basically circumvent the supply restrictions. Can a AI allow a radiologist to review 4 times as many images because they are just having to double check an AI's work rather than do it entirely themselves? Will AI be allowed to basically replace primary care doctors for a lot of people, with their interaction solely being with the techs that draw blood, take pictures or do imaging, and do other physical tasks a robot can't do yet, with internists or general practitioners being regulated to spot checking AI work or looking at edge cases AI flags? Can AI take care of a lot of the "file building" that providers have to do, so they allow them to effectively see more patients by reducing their paper work? Can AI reviewing files and aggregating them allow them to reduce errors, thereby freeing up capacity by reducing the number of people taking up hospital beds and resources due to malpractice?
All of those are reasonably possible (ignoring the politics), but I'm not sure how far off they are. And at the end of the day most people probably won't like it.
That's not true. You have two anecdotal experiences to back up your claim. I have an aunt in France that would beg to differ (see my previous post). I also have a very close friend, and another acquaintance who have both lived in Germany for around a decade each. While it's pretty good there, overall, it's not without it's problems. They typically suffer long wait times. Many people choose to buy private insurance (similar to France), and those patients typically receive better care and in a more timely manner. They also face rising costs and an overburdened system, just like us, because they have the same problem we do - an aging population.
There are pros and cons everywhere, and there is no grand solution out there. My aunt and mom both had stage 3 breast cancer. My mom in the US, and my aunt in France. I can tell you without a doubt that my mom had a much better experience with the healthcare system.
How's that going to work out if someone in your family gets cancer, has a stroke or heart attack, or something else real serious?
Man, I can't wait till I can get on Medicare. Access to good health insurance is one reason I'm still working now.
You said healthcare was so tilted to the elderly that the free market can't handle it. And that's just false. We don't have to take money from the young and give it to the old. "We" choose to. You could treat end of life care like every other retirement expense. You'd see a lot less money allocated to end of life care and it would reduce, but not eliminate, the imbalance because people would be spending what is more or less their money on what they value, instead of other people's money. Most people do not want to give up the amount of consumption necessary when they are young to have extra care when they are 80.
We want to pretend old age can be insured against, and it can't because it is not a risk that can be avoided. If we decided that everybody had to have a $5M life insurance policy renewed every year of their life, regardless of age, we'd find out that the free market can't handle life insurance either.
ETA: But you're right that free markets aren't "magic". But it's also ridiculous to claim that healthcare is a non-market good. People are literally bitching about about how much they pay for healthcare in this thread. It's a market good for which the the goverment has completely distorted the pricing mechanism..
So the answer is simple. We go all in on Logan's Run society except instead of the light turning red at 30 it turns red at 65.
Agree and disagree. I absolutely think the pre-existing conditions problem had to be addressed. I don't think ACA was the best way to do it. I think a handful of standalone requirements could have worked.
Why do you hate America?
Poo-pooing on the magic of the free market system makes baby Jesus cry.
The software I support (mostly rehab) has AI deployed in versions in the field now, where the workflow is indeed aimed at taking pressure off the clinician and letting them see more patients by recording conversations with patients, transcribing them, updating our software's fields with the appropriate data, and then asking the clinicians to sign off on what was produced. That can include medical coding, although I think that's not in every workflow yet.
You hit it out of the park here. Obamacare has been a cluster because it went down the middle road. A lot of people do not realize how big the insurance and healthcare lobby is in this country. The main reason it moved to a middle path is to satisfy the lobby.
I use AI to transcribe my notes. It is a godsend. I spend much longer talking to the patients then I was able to before. If I want something to go on the chart I have to make sure and explain it to the patient in detail which is the way it should be. Now, you sure as hell have to proofread it, but it has greatly improved my days. I’m able to see more patients and get out of the office more quickly.
Plus, it’s an excellent way to train the Terminators on the best way to kill us.