Hospitals

[Go Budaw]

Widgets cost $3 to make. You sell 2,000 at $2 (Medicare/Medicaid) and 1,000 at $6 (Blue Cross) and make $1,000. Give away 200 for free (no insurance) and you still make $400. Then the goverment requires you to sell 3,200 at $2 (M4A) and you lose $3,200.

Except the 1,000 at $6 isn’t based on reality at all. Blue Cross comes back and says “all of these other places are only charging us $2.25, so that’s what we are paying”.

Also, I can’t tell you how many medical bills my wife and I have gotten for very standard minor procedures and diagnostics in the past 5 years where the insurance statement comes back and states that the insurance company negotiated 80% of the cost out of the bill. Then the amount the insurance paid after the negotiation? A lot of times it is straight up nothing. The entire system is a joke. Providers throw a 400% - 500% mark up on these services and the only people that ever get finally charged that are folks with no insurance.

 

[J-Dawg]

Yep. Best in the world. . .except for about 30 other countries.

Yeah, I remember reading all those articles on how people flock to Mayo Clinic, MD Anderson or St. Jude in those other countries...... oh wait.

 

[dorndawg]

LOL "cost plus a little"

 

[HailStout]

I’m a doctor and i have no idea what you are talking about. Number one, I sure as hell am not a multimillionaire. I wish I was. Neither I nor any physician I work with is being made a multimillionaire by the hospital. I also don’t understand the “restricting the supply” of doctors statement. Are you implying that there is just an overabundance of physicians out there and the hospitals are somehow just controlling this the way the diamond supply is controlled? The truth is there are not enough physicians to go around. We are constantly recruiting more. If I am misunderstanding what you are saying then please let me know. I will say your statement is 100% inaccurate on the part pertaining to the ‘super rich” physicians. I wish to god that stereotype was true. I make a good living, but I’m sure as hell not making it rain

 

[dorndawg]

Furthermore, I'm happy to have a conversation about actual "costs" at hospitals, where an aspirin can go for $12 each in the Charge Master.

 

[LandsurveyorDawg]

Mayo Clinic furloughs or cuts pay to 30,000 employees.
** It's all worth it if we save one life!!! **

 

[dorndawg]

There is an artificially low number of physicians thanks to the AMA & physicians working together.

https://www.theamericanconservative.com/articles/the-doctor-monopoly-is-killing-american-patients/

 

[HailStout]

I don’t even have words to respond to this article. Doctors are running a cartel with the AMA to limit the number of doctor? That is some tinfoil stuff there my brother. I also am member of the Illuminati while we are at it. The greedy doctor stereotype is old and insulting. I get we are an easy target, but we aren’t the bad guys here. Look at insurance companies, hospitals, and the government if you want to point fingers. As far as doctors planning anything as a group, you would be hard pressed to find a group of people less able to get their **** together to accomplish something like that. Seriously, it makes me laugh to even think about it. Also, the AMA represents less than a sixth of the total physicians in America. The few people i knew who were members bailed as soon as the AMA backed Obamacare before it even truly existed. Once agin, I get we are easy targets, but the vast majority of us just go to work and do our jobs. I have never understood the hatred we seem to receive from some people.

 

[DAWG61]

You know why Faux News wasn't talking about children in cages and border security 5 years ago? Because Trump hadn't started bleeting and bragging at his rallies about it yet. When Trump started bleeting non-stop about Build the Wall is when border security became something the media could sell. Both sides of the argument.

 

[J-Dawg]

Worked at the MDEQ for a year (eyeroll).

LOL. I worked at MDEQ as my first job straight out of MSU. I was there a year and a half. The amount of actual meaningful, productive work I did there could be fit into less than 1 week of normal productivity at my current role in the private sector. Not lying in the slightest. I think I edited a paper for 2 or 3 months just to have something to do. 80% of the time I was there was thumb-twiddling, 5% was 2-3 hour meaningless meetings (mainly about what needs to be met about in other meaningless meetings), 5% was meaningless, PC-garbage trainings, 5% was conference calls about the previous meaningless meetings, and 5% (thats stretching it) was actual productive work. And I'm the type of person to seek out opportunity and not wait for it to come to me. There was literally never anything to do, hence why I didn't stay very long.

Thanks, taxpayers, for wasting your pennies on me!!!***

Also.... "but the GUVBMENT gonna take care of everything! The GUBMENT so efficient and productive!!!*****

 

[J-Dawg]

You know why Faux News wasn't talking about children in cages and border security 5 years ago? Because Trump hadn't started bleeting and bragging at his rallies about it yet. When Trump started bleeting non-stop about Build the Wall is when border security became something the media could sell. Both sides of the argument. If Obama had been excreting non-stop on Twitter like Trump then Faux News woulda been talking about children in cages. Fat Orange face has to go on twitter rants or acting like a psychopath during press conferences first before the media picks up on what it should start peddling to the Tards.

You are a sad individual.

 

[ckDOG]

Fair question. Response: look to the rest of the planet

My biggest question throughout this entire coronavirus mess is how would the media and our country react to this pandemic if Trump wasn’t president & it wasn’t an election year?

For example, if Obama was in office & it was 2013, would the reaction be the exact same? Fear & panic by the media?

I’m sure this question will piss off people, but it’s one to consider

This isn't only American issue. The entire first world had reacted significantly. I have no doubt there is media fear porn to drive clicks and views, but given the global reaction to this thing, it would be far fetched to believe it is all in concert to **** on Trump.

 

[dorndawg]

The AMA very much institutes quotas for medical school admissions. I'm frankly shocked a doctor wouldn't know this.

No one has hatred for doctors, that is obtuse. Do you really think there aren't criticisms of the American medical system?

 

[ckDOG]

I’m a doctor and i have no idea what you are talking about. Number one, I sure as hell am not a multimillionaire. I wish I was. Neither I nor any physician I work with is being made a multimillionaire by the hospital. I also don’t understand the “restricting the supply” of doctors statement. Are you implying that there is just an overabundance of physicians out there and the hospitals are somehow just controlling this the way the diamond supply is controlled? The truth is there are not enough physicians to go around. We are constantly recruiting more. If I am misunderstanding what you are saying then please let me know. I will say your statement is 100% inaccurate on the part pertaining to the ‘super rich” physicians. I wish to god that stereotype was true. I make a good living, but I’m sure as hell not making it rain

He's saying that medicine intentionally trains too few docs to keep the wages high. Probably true for some specialities and not others. Not sure how big of an issue there really is bc I do know that academic institutions have a financial incentive to train due to the GME money. Most of residency costs are federally funded. What's cheaper? Heavily subsidized medical school grads doing a lot of the grunt work or hiring a PA?

We can train more docs. We will also have to pay more docs. I'd be more interested if there is a quality of care issue by simply not having enough bodies to do the work well and quickly. if there is, then yes, we need to train more docs or get some of their non-essential work into the hands of cheaper/lesser educated/more plentiful labor.

 

[johnson86-1]

Over here in reality, the overwhelming majority of hospitals don't lose money on Medicare/Medicaid. Why would any of them accept it if so? Anyone saying otherwise has a monetary interest in the status quo.

You don't understand price discrimination and why somebody would take payments that cover marginal costs but not average costs?

 

[johnson86-1]

I’m a doctor and i have no idea what you are talking about.

That's good. THat probably means you're not an *** hole looking to use the government to increase your income.

Number one, I sure as hell am not a multimillionaire. I wish I was. Neither I nor any physician I work with is being made a multimillionaire by the hospital.

If you are in a high cost urban area, that might be true (I have no clue). But if you aren't, that likely means your physician friends are misleading you about what they are being paid, or they are really bad at money, or maybe you are only hanging out with doctors that are say hospitalists that get paid well enough to be rich but I'm sure don't feel like they are raking it in. But I am guessing our local hospitals routinely pays $400k and above for just about any specialists and up to 900's probably for the highest paid ones. The vast majority of those are going to end up multimillionaires early, although a few of them are big enough spenders and/or bad enough with 'investments' that they will need to work until they're 60+. Now all my experience is in areas where hospitals have bought up private practices and made the doctors employees in all but a few specialities. Maybe that is abnormal and hospitals that don't employee all the physicians don't pay as much. These averages look low to me based on the relatively narrow knowledge I have, but that's still showing the average doctor should end up a multimillionaire: https://www.thestreet.com/personal-finance/how-much-do-doctors-make-14779617

I also don’t understand the “restricting the supply” of doctors statement. Are you implying that there is just an overabundance of physicians out there and the hospitals are somehow just controlling this the way the diamond supply is controlled? The truth is there are not enough physicians to go around. We are constantly recruiting more. If I am misunderstanding what you are saying then please let me know. I will say your statement is 100% inaccurate on the part pertaining to the ‘super rich” physicians. I wish to god that stereotype was true. I make a good living, but I’m sure as hell not making it rain

There are not enough physicians to go around because we do not allow there to be enough physicians by design. We restrict the supply of medical school spots and restrict the number of residencies available and we also more or less don't let foreign trained doctors practice here unless they go through a residency on US soil, even if they have more or less equivalent training. If we expanded medical school spots and residency spots in proportion to population growth, we'd have many more physicians.

 

[paindonthurt_]

So you are admitting border security is good and the media is bad?

 

[paindonthurt_]

I did the flex schedule.
“Worked” an extra half hr each day plus half hour “lunch”. Off every other Friday.

My day looked like this:
Arrive around 830
Steady work until 10 when my buddy finally got to work
He gambled online for an hr
We left around 11 for lunch
Went to my house and watched a movie 3 times a week
Back around 115ish
Steady work until 3 ish
Sega or Nintendo until I couldn’t stand it anymore
Home by 445 at the latest

Absolute joke.

My immediate boss and his boss told me after 3 months that I needed to go into private industry or corporate world Bc I was too motivated to be stuck in government work.

 

[Big Sheep81]

Yes, lets have that conversation. I'm happy to oblige. Where do you want to start? Oh the $12 aspirin in the master charge list. Ok.

The aspirin comes to the hospital from the supplier. It goes to the pharmacy where there are 2-3 pharmacists pulling down from $85 to $130 per hour (we pay market rate or they go to Walgreens or Walmart). Add in the $1700 per sq ft "clean room" I mentioned earlier in this thread. Then there are the machines used to ensure safe dispensing, the maintainance agreements for the equipment ranging from $500 per month to as much as $2500 per month (or you don't get it worked on for at least 2 months while you wait for your turn as you are not under an agreement), then add in the 2-3 techs @ $15-20 per hour. This is dispensed using a computer with a specialized software program, bar-coded, then loaded onto a $1500 mobile drug dispensing cart. It is taken by either a LPN or an RN to the floor, riding a $360,000 elevator (which has a $8,000 per year maintenance agreement with Otis) to the nurses station. Here there are as many as 5 RN's and LPNs (hourly rates from $18-30 per hour). The med cart is scanned into another system (yes this includes the billing system) that has a hardware cost of around $8,000 plus maintenance agreement cost, and software licensing cost, then taken to the room to be dispensed. Once the nurse enters the patient room an RDIF reading system installed to monitor when the nurses enter and exit the room and logs the time into another computer system with hardware, software, maintenance and license agreements, scans the med with a hand scanner and dispenses the aspirin in a disposable cup.

Meanwhile Blue Cross contracts a 38--42% discount, Medicare a 48-58% discount, and Medicaid pays around 25-28 cents on the dollar. It's a screwed up system and without private insurance patients a hospital works on a thin line. 2-3% "profit" is a really good year. Our hospital has operated in the black for about 75% of the years I have been a board trustee. The bad years have been really bad and without strict management of over-head and expenses, our little hospital would have folded years ago.

But go ahead, tell us how it works since you have no idea in holy hell about what you are talking about.

 

[Big Sheep81]

You have no clue. Medicaid is not the same as medicare or private insurance. It pays somewhere around 25-28 cents on the dollar. Medicaid is paid by the STATE, and is like selling those $3 cost to make widgets for 50 cents. Medicare allows a larger margin, but is now paying a lump sum for diagnostic codes, i.e. "outcome based". So if a patient does not do well the hospital eats the additional cost. And of course, ALL patients follow the doctor's orders, eats a balanced diet, exercises and has regular wellness visits.

I hope are able to get your head out of your *** without choking to death on the rim of your *******.