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Medicare Patients - Vote, as if your life depends on it.

The scariest part IS NOT the actual healthcare part, it's all the other fun stuff they have hidden in that 2700 pages. For all we know it could give the pope permission to launch babies out of a cannon on to unsuspecting puppies.
 
joko104 said:
Hmmm... does anyone have the text of the exact regulation? Or a detailed fact-explanation rather than editorial explanations.
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Respectfully, Joko, you seem to know so much about it . . . where did you get your information? Mine is anecdotal.
 
Follow-up visits to a Doctor should not be viewed as a hospital stay.
 
specklebang said:
Follow-up visits to a Doctor should not be viewed as a hospital stay.
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They wouldn't be a hospital stay. No one is admitted to the hospital just for a doctor's appointment.
 
I think what the reg is trying to do here is crack down on hospitals with more than average re admittance levels. Not necessarily a bad thing, cost wise, but case by case I would hope would be scrutinized as well...Older people tend to visit the hospital more as they get older...Now as for the political spin, this ought to be good....
 
MaggieD said:
Respectfully, Joko, you seem to know so much about it . . . where did you get your information? Mine is anecdotal.
Click to expand...

Media editorial commenting - meaning I really could be really off. I'll try to find out more and will acknowledge I'm been inaccurate if I have.

As for the $175 cost, what hospitals charge doesn't necessarily reflect their costs. Its just what hospitals charge.

The real problem we are seeing - we are in an area of Florida where seniors are the majority of the population - is about the psychology of doctors - which I think is predictable. Most doctors do NOT work in hospitals. Around here it is almost impossible to find a doctor that will work ER or at the hospital - though there is a notably large number of doctors per population around here due to the number of seniors. However, most seniors are middle class or higher, meaning do have insurance and most do have $$.

Doctors want to be doctors. And then paid to be doctors. They want to make doctoring decisions themselves. They don't want to fight for their money, they don't want to fill out piles of claims forms, and particularly don't want to fight with the government just to get paid - or wait months for their money. That is very real to them.

Here's a personal example. The ONLY time I had ever been to a doctor was on my wife's request for a routine physical - which I'd never had. Her total medical bills just in the last few years goes well over a million, but that's another matter. At that physical, to my surprise the doctor(s) said I have a very serious heart condition likely due to childhood injury(s). My heart was so dislocated or bounced around or whatever that key veins were increasingly being restricted, which could lead to sudden heart failure. In short, they wanted to install "stints" - rare for someone my age. Cost? $28,000. They would not do it for free if we were poor.

My wife had never been to a heart specialist or any related care, so it began with the usual "who do you have insurance with?" Answer, "none, but we can pay." That instantly dropped to $14,000 for not having to deal with insurance.

For $14,000 in 3 weeks they could do the surgery, provided a payment plan reached with at least a couple thousand down and assuming I had decent credit. "No, I will be paying in cash. 20s or 100s, whichever you prefer," telling them let me think about it before giving a final decision on the surgery. The nurse called later that day, saying it would be $7000 if in "cash" and they could do the surgery the day after tomorrow if I decided to have it done. Cash eliminated bill collecting, payment plans, reporting to credit bureaus etc - in short assurance of being paid in full up front with no money-paperwork other than a receipt on different than shopping at a store.

The surgery went fine and I was out the next AM. Yes, I did go back for followup. Everything A-OK.

$28,000 down to $7000 because of there is no paperwork other than a receipt for cash and the doctor(s) and facility know for certain they are going to be paid because they are paid cash before they start. I was offering exactly what the doctors/professionals wanted. To do their job, get paid and be done with it - just like any other business person. We know that from my wife and children - we always pay cash - and we are never turned down, never a delay, and always only a fraction of what others pay thru insurance or medicare/cad

There is an inherent destructive force anytime restrictive rules - particularly requiring paperwork, fines, reductions in pay and delay or uncertainly in pay becomes involved. Doctors hate all complexities outside being a doctor, hate paperwork, hate overseers, hate being bill collectors and don't like additional burdens and risks being put on them. Since there are far more patients than there are doctors, they don't feel like they have to be beggars for their fees.

Personally, I believe the entire indigent and medicare system should be totally revamped, and in some regards the entire medical system including education for medical professionals. But that is a different topic. The #1 problem is to increase the number of doctors and medical professionals - an entirely different topic and problem area.
 
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joko104 said:
Except poor people. So it is only poor people Obama want to kill off. Part of his debt reduction plan and how to cover some of that $700 billion taken away.
Click to expand...

Looky here... a far flung off the mark assessment from a guy lining up with the party that's trying to completely disban medicare and medicaid.. and Social Security... and welfare... all while pretending to have some new found concern for the poor.
 
joko104 said:
Media editorial commenting - meaning I really could be really off. I'll try to find out more and will acknowledge I'm been inaccurate if I have.

As for the $175 cost, what hospitals charge doesn't necessarily reflect their costs. Its just what hospitals charge.

The real problem we are seeing - we are in an area of Florida where seniors are the majority of the population - is about the psychology of doctors - which I think is predictable. Most doctors do NOT work in hospitals. Around here it is almost impossible to find a doctor that will work ER or at the hospital - though there is a notably large number of doctors per population around here due to the number of seniors. However, most seniors are middle class or higher, meaning do have insurance and most do have $$.

Doctors want to be doctors. And then paid to be doctors. They want to make doctoring decisions themselves. They don't want to fight for their money, they don't want to fill out piles of claims forms, and particularly don't want to fight with the government just to get paid - or wait months for their money. That is very real to them.

Here's a personal example. The ONLY time I had ever been to a doctor was on my wife's request for a routine physical - which I'd never had. Her total medical bills just in the last few years goes well over a million, but that's another matter. At that physical, to my surprise the doctor(s) said I have a very serious heart condition likely due to childhood injury(s). My heart was so dislocated or bounced around or whatever that key veins were increasingly being restricted, which could lead to sudden heart failure. In short, they wanted to install "stints" - rare for someone my age. Cost? $28,000. They would not do it for free if we were poor.

My wife had never been to a heart specialist or any related care, so it began with the usual "who do you have insurance with?" Answer, "none, but we can pay." That instantly dropped to $14,000 for not having to deal with insurance.

For $14,000 in 3 weeks they could do the surgery, provided a payment plan reached with at least a couple thousand down and assuming I had decent credit. "No, I will be paying in cash. 20s or 100s, whichever you prefer," telling them let me think about it before giving a final decision on the surgery. The nurse called later that day, saying it would be $7000 if in "cash" and they could do the surgery the day after tomorrow if I decided to have it done. Cash eliminated bill collecting, payment plans, reporting to credit bureaus etc - in short assurance of being paid in full up front with no money-paperwork other than a receipt on different than shopping at a store.

The surgery went fine and I was out the next AM. Yes, I did go back for followup. Everything A-OK.

$28,000 down to $7000 because of there is no paperwork other than a receipt for cash and the doctor(s) and facility know for certain they are going to be paid because they are paid cash before they start. I was offering exactly what the doctors/professionals wanted. To do their job, get paid and be done with it - just like any other business person. We know that from my wife and children - we always pay cash - and we are never turned down, never a delay, and always only a fraction of what others pay thru insurance or medicare/cad

There is an inherent destructive force anytime restrictive rules - particularly requiring paperwork, fines, reductions in pay and delay or uncertainly in pay becomes involved. Doctors hate all complexities outside being a doctor, hate paperwork, hate overseers, hate being bill collectors and don't like additional burdens and risks being put on them. Since there are far more patients than there are doctors, they don't feel like they have to be beggars for their fees.

Personally, I believe the entire indigent and medicare system should be totally revamped, and in some regards the entire medical system including education for medical professionals. But that is a different topic. The #1 problem is to increase the number of doctors and medical professionals - an entirely different topic and problem area.
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The discount isn't because they don't have to deal with paperwork. You can bet that the insurance companies and Medicare/Medicaid are getting an even better price. They just quote outrageous fees because some people are dumb enough to pay them.
 
Uh, yes, I think that's what I said.
AdamT said:
They wouldn't be a hospital stay. No one is admitted to the hospital just for a doctor's appointment.
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That would not be possible in the hospitals anywhere near me. There would have been separate bills for every doctor who saw you, the anesthesiologists, the back up surgeon, the hospital, the radiologist who mapped your arteries, the radiologist who reviewed all the tests done during the surgery, and the people who did the surgery clearance examination for the hospital just off the top of my head. Even if they are all part of the hospital operations, they bill separately.
 
AdamT said:
The discount isn't because they don't have to deal with paperwork. You can bet that the insurance companies and Medicare/Medicaid are getting an even better price. They just quote outrageous fees because some people are dumb enough to pay them.
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What you posted is false. It is routine that people who cash pay in ER receive a 50% discount over what would be billed to insurance companies as that is our local hospital's open policy - 50% off for cash pay over the insurance bill, for which those patients have to pay their 20% co-pay.

I obviously can not know (nor can you) what they would have charged Medicare - and doing so would be impossible as they don't take Medicare patients anyway. I do know from my wife's experience that they charge at least 50% more to state (government) V.O.C. than they did for cash pay.

I understand you think anyone who pays for their own medical care is "dumb." The art of being a deadbeat who bleeds on and off of others seems a common partisan hackery raging of your messages on nearly any government, institutional or political topic.
 
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joko104 said:
That is false. It is routine that people who cash pay in ER receive a 50% discount over what would be billed to insurance companies.
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Joko, I've dealt with my own private health insurance for my whole life. Never had a group policy. A typical billing to my insurance company might be $125 for an X-ray. My insurance company? Their deal with the hospital is to pay about $30.00. I am telling you the truth. I am floored at the discount the insurance company gets. I use Blue Cross Blue Shield. They probably have one of the best deals in the country. Pap smear laboratory charges? About ten bucks. The billing system used by doctors (and hospitals) is outrageous. Talk about lack of transparency! My doctor charged $120 for an office visit. I didn't want to run it through my insurance company and asked for a discount. The gal at the counter said no. So I ran it through. I would have paid the $120 -- at that time I didn't know any better. My insurance company paid him $60.
 
Nearly all political talk seems mostly to be just partisan sloganism with little attachment to actual reality.

The reality is that most doctors, like nearly all highly educated professionals, go to where the money is professionally in terms of practice. For most doctors, that means staying away from hospitals and particularly ER - and mostly from indigent and medicare/cad practice. A flaw of most discussion of medicare/medicad and indigent health care is a presumption that there will be enough doctors willing to play along - and there aren't.

It isn't for economic reasons that people who can pay or have full traditional insurance avoid the area hospital and ER like the plague if any way possible.
 
MaggieD said:
Joko, I've dealt with my own private health insurance for my whole life. Never had a group policy. A typical billing to my insurance company might be $125 for an X-ray. My insurance company? Their deal with the hospital is to pay about $30.00. I am telling you the truth. I am floored at the discount the insurance company gets. I use Blue Cross Blue Shield. They probably have one of the best deals in the country. Pap smear laboratory charges? About ten bucks. The billing system used by doctors (and hospitals) is outrageous. Talk about lack of transparency! My doctor charged $120 for an office visit. I didn't want to run it through my insurance company and asked for a discount. The gal at the counter said no. So I ran it through. I would have paid the $120 -- at that time I didn't know any better. My insurance company paid him $60.
Click to expand...

Interesting. So when hospitals and insurance companies require "co-pay" - it is a routine massive fraud? If the insurance company required a 20% co-pay on a bill of $125 ($25.00) and then the insurance company only paid $30? If that is routine practice in the insurance industry a law firm has a trillion dollar class action lawsuit.

What you state also seems to contradict the claim of how outrageously costly it is for the government to pay people who go to the hospital.

We also may personally be dealing routinely with different doctors operating on a different pattern of pricing. We know a few personally, including socially. If an insurance company will not pay their billing, they add that insurance company to their posted list of insurnance they will not accept. For the most part, she is seeing highly specialized pros, rather than what some people call treadmill medical practice. If it ever entered a new specialization field, we would do a great deal of inquiry to learn which was the absolute best irregardless of any economic considerations.

For our family practice doctor (minor stuff), we pay $75 for adult office visits and $50 for the children. He also has the longest posted list of what insurance, government pay and types of patients he won't see (anything that might involve lawsuits). The other family practice doctor we see is a flat $60 for office visits. He also has a long list of who he won't accept as a patient and insurance/government plans he won't accept. This latter doctor rages against all the government and insurance regs, delays and refusals to pay - for which he finally just said "no more!" In terms of knowing all a general practice doctor must know, it is brilliant in both traditional and alternative treatment.

People also may not be aware how many doctors are going underground and under the radar of government and AMA rules and restrictions on treatments and therapy.
 
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joko104 said:
Interesting. So when hospitals and insurance companies require "co-pay" - it is a routine massive fraud? If the insurance company required a 20% co-pay on a bill of $125 ($25.00) and then the insurance company only paid $30? If that is routine practice in the insurance industry a law firm has a trillion dollar class action lawsuit.
Click to expand...

Typically copays are not stated in percentage terms. If you have a $25 copay for a doctor visit it's $25 whether the bill is $25 or $25,000.

I didn't say that people who pay for their own medical care are dumb -- don't put words in my mouth. I said that people who don't negotiate a better price are dumb. Well, that may have been ungenerous. Americans are generally not used to bargaining over bills in most cases. But with medical care, as you discovered, the doctors and hospitals will screw you to the wall if you don't question them.
 
MaggieD said:
Joko, I've dealt with my own private health insurance for my whole life. Never had a group policy. A typical billing to my insurance company might be $125 for an X-ray. My insurance company? Their deal with the hospital is to pay about $30.00. I am telling you the truth. I am floored at the discount the insurance company gets. I use Blue Cross Blue Shield. They probably have one of the best deals in the country. Pap smear laboratory charges? About ten bucks. The billing system used by doctors (and hospitals) is outrageous. Talk about lack of transparency! My doctor charged $120 for an office visit. I didn't want to run it through my insurance company and asked for a discount. The gal at the counter said no. So I ran it through. I would have paid the $120 -- at that time I didn't know any better. My insurance company paid him $60.
Click to expand...

Medicare/medicaid typically get the best write-offs. For instance, a doctor charges $175 for walking in the door. Insurance/Medicaid/Medicare only allow say $55. You pay your copay if you have one based on the allowed amount, the insurance pays what they pay to get you to the allowable charge, and the doctor eats the rest IF they are a participating provider. If they are not a participating provider of your insurance then you have to pay them the whole amount and send everything in yourself to your insurance, and they send you the check back for the part they would have paid.
 
lonewolf said:
Millions of americans will be effected by a little known part of the Obamacare that went into effect this week Hospitals will be fined big if too many of Medicare patients have to return to the hospital within 30 days. Many people do have to go back to the hospital for followup care.

Obamacare push the hospital to discharge the patient as soon as possible. The penalty is going to apply to all Medicare patients.

What about care? If the patient has pneumonia many times the hospital will send the patient home but it can get worse and pneumonia can kill you. If the pneumonia patient is sent home but if they get worse the the hospital is not allowed to re-admit the patient or the hospital will be fined for re-admitting the Medicare patient.

Anyone who post that Obamacare is good does not have a clue about healthcare.
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Anyone that believes this take on the Affordable Care Act does not have a clue about the Affordable Care Act.

This particular provision of the ACA is designed to attack a major inefficiency in Medicare reimbursements. Studies have found that certain hospitals and rehab centers have a tendency to have higher re-admissions than others. This provision attempts to eliminate and/or mitigate some of the root causes including sloppy discharge planning, poor post hospitalization care plans, poor compliance therewith, poor record keeping... generally just sloppy back-end work that results in the patient returning to the hospital. Under the current plan, hospitals get to start the ticker over and bill full rates. Under the new plan, hospitals with higher than average re-admission rates will have there re-imbursements impaired on readmission. The purpose of this is to force hospitals that have higher re-admission rates to review practices and improve processes lest they face this penalty. This is a series of rewards and penalties designed to leverage the natural economic forces of the free market to create efficiency. This is good management!

http://www.ncsl.org/documents/health/Medicare_Hospital_Readmissions_and_PPACA.pdf

Much of the so-called $716B that some as suggested is being "taken" from Medicare is this cost containment program, with the $716B the anticipated savings (not all this, but this is one of the largest cost containment initiatives).

And for those that still find outrage with this; private health insurance and pre-ACA Medicare operate in the same matter... most procedures are paid on a schedule, with your insured hospital stay paid for a set number of days and diminished as those days exceed the average for the particular procedure. Hospitals will run you out the door when your insurance runs dry as fast as they will under Medicare.

Funny, Washington comes up with a way to use the free market to force efficiency and suddenly those that normally believe in the free market are suddenly (and disingenuously) outraged.

So many outraged people, with so few that actually have a clue. Remember, ACA-Massachusetts (by Romney) actually has a 60+% approval rating.

http://www.nytimes.com/2011/06/10/opinion/10fri4.html
 
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AdamT said:
Typically copays are not stated in percentage terms. If you have a $25 copay for a doctor visit it's $25 whether the bill is $25 or $25,000.

I didn't say that people who pay for their own medical care are dumb -- don't put words in my mouth. I said that people who don't negotiate a better price are dumb. Well, that may have been ungenerous. Americans are generally not used to bargaining over bills in most cases. But with medical care, as you discovered, the doctors and hospitals will screw you to the wall if you don't question them.
Click to expand...

OK, I understand your distinction and clarification.

I was mixing up terminology.
Copay versus Coinsurance
Coinsurance Vs. Copay



Coinsurance is just what the term suggests. It is an insurance component whereby, you pay a small percentage of the health care expenses, while the rest is covered by the insurer. This is usually a percentage split deal like 80/20 or 70/30, whereby you either pay 20% or 30% of the expenses while the rest is paid by the insuring company. This is only after your health care expenses have exceeded deductibles. Coinsurance is a standard feature in most health insurance schemes.
Read more at Buzzle: Coinsurance Vs. Copay

We have a friend who was putting off cancer treat because he did not have his $6000 20% share of $30,000 they required - and would not act until he paid his co-pay. We gave him the $6000.

Did the insurance really pay the other $24,000? Or much less for which a fraud was worked against him by the insurance company and/or doctors?
 
joko104 said:
We have a friend who was putting off cancer treat because he did not have his $6000 20% share of $30,000 they required - and would not act until he paid his co-pay. We gave him the $6000.

Did the insurance really pay the other $24,000? Or much less for which a fraud was worked against him by the insurance company and/or doctors?
Click to expand...

That's a good question that he should ask his insurance company -- if it isn't apparent from the documents they've sent him.
 
straykatz said:
Follow up care after hospitalization is generally done with your primary care physician not the hospital
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Yes one of the key issues with Obama Care is that it encourages primary care and reduces specialists, making the system more efficient.
 
shiang said:
Yes one of the key issues with Obama Care is that it encourages primary care and reduces specialists, making the system more efficient.
Click to expand...


We know of NO primary care ("family doctors") in this whole area under age 60. I read somewhere 50%+ of family practice (primary care) doctors will retire over the next 10 years, with virtually no medical students going into that field. The crisis in medical care isn't just in government and money - though G-people think everything is 100% about them and what they do for people. It is as simple as there are not enough people in or entered the needed medical fields.

http://www.nytimes.com/2008/09/30/health/30brod.html?_r=0I
According to a study published this month in The Journal of the American Medical Association, the number of medical students choosing to train in internal medicine is down, and young physicians are leaving the field. Other primary care specialties, including family medicine and gerontology, have also reported drops.

Primary care doctors spend far more time talking to patients and helping them avert health crises or cope with ailments that are chronic and incurable than they spend performing tests and procedures.

They are the doctors who ask pertinent questions, about health and also about life circumstances, and who listen carefully to how patients answer. They are the doctors who know their patients, and often the patients’ families, and the circumstances and beliefs that can make health problems worse or impede effective treatment.

The problem is that in this era of managed care and reimbursements dictated by Medicare and other insurers, doctors don’t get much compensation for talking to patients. They get paid primarily for procedures, from blood tests to surgery, and for the number of patients they see.

Most are burdened with paperwork and hours spent negotiating treatment options with insurers. And the payments they receive for services have not increased as the costs of running a modern medical practice have risen. To make ends meet and earn a reasonable income of, say, $150,000 a year, many primary care doctors have to squeeze more and more patients into the workday.

(more in the article).

Daydreaming of fantasy realities and then making laws around the fantasy was a real problem for W. Bush. It is a worse one for B. Obama.
 
joko104 said:
We know of NO primary care ("family doctors") in this whole area under age 60. I read somewhere 50%+ of family practice (primary care) doctors will retire over the next 10 years, with virtually no medical students going into that field. The crisis in medical care isn't just in government and money - though G-people think everything is 100% about them and what they do for people. It is as simple as there are not enough people in or entered the needed medical fields.

http://www.nytimes.com/2008/09/30/health/30brod.html?_r=0I
According to a study published this month in The Journal of the American Medical Association, the number of medical students choosing to train in internal medicine is down, and young physicians are leaving the field. Other primary care specialties, including family medicine and gerontology, have also reported drops.

Primary care doctors spend far more time talking to patients and helping them avert health crises or cope with ailments that are chronic and incurable than they spend performing tests and procedures.

They are the doctors who ask pertinent questions, about health and also about life circumstances, and who listen carefully to how patients answer. They are the doctors who know their patients, and often the patients’ families, and the circumstances and beliefs that can make health problems worse or impede effective treatment.

The problem is that in this era of managed care and reimbursements dictated by Medicare and other insurers, doctors don’t get much compensation for talking to patients. They get paid primarily for procedures, from blood tests to surgery, and for the number of patients they see.

Most are burdened with paperwork and hours spent negotiating treatment options with insurers. And the payments they receive for services have not increased as the costs of running a modern medical practice have risen. To make ends meet and earn a reasonable income of, say, $150,000 a year, many primary care doctors have to squeeze more and more patients into the workday.

(more in the article).

Daydreaming of fantasy realities and then making laws around the fantasy was a real problem for W. Bush. It is a worse one for B. Obama.
Click to expand...

Which is why we need to encourage the expansion of primary care doctors. It's not good if every doctor is a specialist. It's better to first go to a general "family" doctor then have him direct you to specialists when needed.

This also shifts the focus from ER to preventions, saving money.
 
shiang said:
Which is why we need to encourage the expansion of primary care doctors. It's not good if every doctor is a specialist. It's better to first go to a general "family" doctor then have him direct you to specialists when needed.

This also shifts the focus from ER to preventions, saving money.
Click to expand...

There has to be the doctors first before building a system around doctors in general practice that don't exist. That is the reason such systems in other countries produce waiting lines of days, weeks and months.
 
joko104 said:
There has to be the doctors first before building a system around doctors in general practice that don't exist. That is the reason such systems in other countries produce waiting lines of days, weeks and months.
Click to expand...

If there's more demand for primary doctors then more people will go to school for it. It's a gradual system too Obamacare makes gradual changes all the way to 2020. Stuff like fines don't kick in till I think 2018. You can go read up on it.
 
shiang said:
If there's more demand for primary doctors then more people will go to school for it. It's a gradual system too Obamacare makes gradual changes all the way to 2020. Stuff like fines don't kick in till I think 2018. You can go read up on it.
Click to expand...

Unless doctor pay is tamped way down, government provided healthcare will bankrupt the nation, but then people will not want to go into medicine if they are not making $250K a year. There are major systemic problems not being addressed by Obamacare.
 
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