sarahruby
Full Member
Posts: 311
Jul 1, 2014 0:40:17 GMT
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Post by sarahruby on Aug 24, 2014 22:33:38 GMT
Hey everyone...I am in a medical coding program and having to write a paper on other's opinions. Will you help me out?
Well as you see around you, experienced, read, or observed others go through (expectations, expenses, what benefits, etc) about their healthcare? What costs do the lawyers contribute to the cost of healthcare and how? What is the preferred system of the physician/hospitals? How money should be spent and who should spend it? What about benefits and treatments? What should be covered? What limitations? How do all the parties feel about these issues?
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gsquaredmom
Pearl Clutcher
Posts: 4,092
Jun 26, 2014 17:43:22 GMT
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Post by gsquaredmom on Aug 24, 2014 22:52:22 GMT
MY opinion: people want good healthcare but do not want to pay for it. They want the best doctors but do not want to pay for them. They want good insurance but do not want to pay for it. They say they want healthcare for everyone but they do not want to pay for it.
Still my opinion: healthcare costs have spiraled out of control because of the insurance and pharmaceutical industries.
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Post by laureljean on Aug 24, 2014 23:28:37 GMT
MY opinion: people want good healthcare but do not want to pay for it. They want the best doctors but do not want to pay for them. They want good insurance but do not want to pay for it. They say they want healthcare for everyone but they do not want to pay for it. Still my opinion: healthcare costs have spiraled out of control because of the insurance and pharmaceutical industries. I agree, especially with the part about the root cost of out of control health care costs. I think more than healthcare reform, we need insurance reform.
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Post by Regina Phalange on Aug 25, 2014 0:08:21 GMT
Hey everyone...I am in a medical coding program and having to write a paper on other's opinions. Will you help me out?
Well as you see around you, experienced, read, or observed others go through (expectations, expenses, what benefits, etc) about their healthcare? What costs do the lawyers contribute to the cost of healthcare and how? What is the preferred system of the physician/hospitals? How money should be spent and who should spend it? What about benefits and treatments? What should be covered? What limitations? How do all the parties feel about these issues?
I think that malpractice lawyers are a huge part of healthcare costs. I know many physicians who've had to give up their general practice and become a part of a healthcare system because they could no longer afford malpractice insurance. I don't think that lawyers should be allowed to advertise for clients every time they hear of a procedure went wrong. When I watch those commercials, a lot of times I think that most of the complications mentioned were probably discussed with the patient before they went into surgery. Nowadays people sue their doctors if they aren't satisfied with the result of surgery. There are no guarantees.
My Mom worked for neurosurgeons, and one day one of the docs came back from court in tears. They were going to have to pay out a large sum of money because a rod that he used when fixing someone's back broke. The lawyer sued the hospital, the doctors who did the surgery as well as the company that manufactured the rod. The doctor wasn't upset that he was losing money, he was upset that he tried to help this person by fixing them, and they turned around and sued HIM for something he had no control over. How was he to know the rod would break?
I think they should put limits on malpractice awards except for in extreme or obvious cases.
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lindy
Shy Member
Posts: 29
Jun 26, 2014 0:15:26 GMT
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Post by lindy on Aug 25, 2014 0:59:11 GMT
This is an excellent infographic on waste in health care and how it contributes to costs: resources.iom.edu/widgets/vsrt/healthcare-waste.html Each of your questions is an essay unto itself. Right now health care is undergoing a massive transition, not only because of the mandates in the ACA, but also because the model was not sustainable. Costs were rising too fast and too many people aren't being effectively treated for conditions that when they spiral out of control end up costing tens of thousands of dollars in treatment. Medicine has been reactive for too long. The new Patient Centered Medical Homes and Comprehensive Primary Care models are finally moving medicine to a robust preventive model. This is what will make a huge difference in costs and overall population health.
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Post by pmm on Aug 25, 2014 2:34:29 GMT
I don't know if this will help you with your paper but here is my 2 cents. I work in healthcare if that makes a difference to you.
Healthcare is broken, I think that most people will agree. The new guidelines tie reimbursement to performance. Basically, did you get a good review from your patients. I feel like we are in the hospitality industry now.
I am a respiratory therapist. I deal with adults who primarily can't breath. They can't breath because they have smoked for many years and now have lung disease. Many continue to smoke despite being told by medical professionals that they need to quit. I am required on initial contact to ask them "Do you smoke?" and if they do follow it up with "Would you like information on quitting?" Most will answer the question simply and we move on. Everyday there is a least one that gets their feathers ruffled and makes a big deal out of my questioning. I remind them that I ask everyone these questions and that the hospital requires me to ask the question. It still pisses them off.
The other thing that is tied to hospital reimbursement is readmission to the hospital within 30 days for having difficulty with your breathing. Healthcare providers can not make these people quit smoking and take their medications as ordered. There are also a number of individuals that unfortunately can not afford their medications. They are doing the best they can by trying to stretch their 30 day supply of breathing meds to 60 days. There just aren't a ton of resources out there for people in these situations.
That sure is long winded! I hope you find something useful for your paper.
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Deleted
Posts: 0
Oct 10, 2024 20:29:20 GMT
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Post by Deleted on Aug 25, 2014 2:45:18 GMT
I do medical transcription. I type charts on about 50 patients a day, mostly elderly. Imho, the advances in medical technology, medications, and general knowledge (we're all taking better care of ourselves) have created a population who expects - no, demands - to live longer, without pain, symptoms, or discomfort. We are trying to defy the natural order of things which is - our bodies age and die. Our expectations of health care are out of whack with physical reality.
Doctors do their best. I think they'd prefer to be paid a reasonable rate (without jacked up insurance costs added in) in cash so they could pay their own bills - medical staff, malpractice insurance, technology they're forced to comply with (even when they don't agree with it), and, oh yeah, a salary for all their hard and compassionate work.
Yes, costs are out of control because of insurance companies, drugs, etc. but all of that lies at OUR feet, the patients who demand the unsustainable and don't have the means to pay for it all.
PS: That's a lot of really broad questions. Are you supposed to answer all of them in one assignment?
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Post by megop on Aug 25, 2014 3:17:59 GMT
I wish I had to the time to reflect on each of your questions, as I could write volumes from working within one of the organizations being successful as an ACO.
But I'll just go with Lindy's post as a place for you to begin researching your answers as she put it much better than I could succinctly.
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Post by megop on Aug 25, 2014 3:22:57 GMT
Basically, did you get a good review from your patients. I feel like we are in the hospitality industry now.
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I want to comment on this...
Reimbursements are tied to patient satisfaction, but also outcomes. And yes, we are in the hospitality industry now. More and better patient engagement, equals more and better patient treatment compliance, equals better outcomes, lower costs and higher patient satisfaction. The triple aim.
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Post by megop on Aug 25, 2014 3:33:11 GMT
Baseline for your questions, by and large the population is used to a fee-for-service delivery model. Meaning....I'm sick...I see provider...I feel better and I move on. That is not sustainable. That is what we had. A very large premise of the ACA and what it demands from health-care providing entities, is evidence-based medicine practices, higher patient engagement for compliance, and quality outcome demands. It's a very, VERY big shift that is going on between what the population has been used to (liken it to I have the flu (virus) and I need an antibiotic (not appropriate treatment) to the mindset of "I have the flu...well why is your immune system such that you are succumbing to it more than others. Shifting a population mindset, will take most certainly take, herculean customer service techniques for them to feel heard and taken care of meaningfully.
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Post by jamieson on Aug 25, 2014 3:49:20 GMT
Agree with Lindy and Megop, too much to say on all your topics. (i just had shoulder sugery and don't have use of my dominant arm, so forgive my brevity.) Check out this new model a lot of docs here are moving to: link
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Deleted
Posts: 0
Oct 10, 2024 20:29:20 GMT
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Post by Deleted on Aug 25, 2014 3:55:46 GMT
I prefer the option of paying for my own day to day health care needs in cash after having shopped my choices and providers. I would appreciate a tax benefit to doing so.
I would like to be able to participate in an insurance plan that is truly affordable, given the above, that covers only catastrophic biggies--cancer, transplants, etc.
I don't need or want a bunch of paperwork, government blah blah blah.
Simple is way better, in my opinion. But I suppose that would lessen the need for coders...so sorry about that.
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Post by Regina Phalange on Aug 25, 2014 16:28:06 GMT
This is an excellent infographic on waste in health care and how it contributes to costs: resources.iom.edu/widgets/vsrt/healthcare-waste.html Each of your questions is an essay unto itself. Right now health care is undergoing a massive transition, not only because of the mandates in the ACA, but also because the model was not sustainable. Costs were rising too fast and too many people aren't being effectively treated for conditions that when they spiral out of control end up costing tens of thousands of dollars in treatment. Medicine has been reactive for too long. The new Patient Centered Medical Homes and Comprehensive Primary Care models are finally moving medicine to a robust preventive model. This is what will make a huge difference in costs and overall population health. Great post Lindy! I remember back when I was seeing an endocrinologist, and they wanted me to go to a nutritionist, but it wouldn't be covered unless I had a diagnosis of diabetes. So, they wouldn't help try and PREVENT diabetes, but were willing to be there once it was diagnosed. That has NEVER made sense to me.
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Post by Regina Phalange on Aug 25, 2014 16:29:24 GMT
I don't know if this will help you with your paper but here is my 2 cents. I work in healthcare if that makes a difference to you. Healthcare is broken, I think that most people will agree. The new guidelines tie reimbursement to performance. Basically, did you get a good review from your patients. I feel like we are in the hospitality industry now. I am a respiratory therapist. I deal with adults who primarily can't breath. They can't breath because they have smoked for many years and now have lung disease. Many continue to smoke despite being told by medical professionals that they need to quit. I am required on initial contact to ask them "Do you smoke?" and if they do follow it up with "Would you like information on quitting?" Most will answer the question simply and we move on. Everyday there is a least one that gets their feathers ruffled and makes a big deal out of my questioning. I remind them that I ask everyone these questions and that the hospital requires me to ask the question. It still pisses them off. The other thing that is tied to hospital reimbursement is readmission to the hospital within 30 days for having difficulty with your breathing. Healthcare providers can not make these people quit smoking and take their medications as ordered. There are also a number of individuals that unfortunately can not afford their medications. They are doing the best they can by trying to stretch their 30 day supply of breathing meds to 60 days. There just aren't a ton of resources out there for people in these situations. That sure is long winded! I hope you find something useful for your paper. WOW. That reminds me of No Child Left Behind!! That's awful!!
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Deleted
Posts: 0
Oct 10, 2024 20:29:20 GMT
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Post by Deleted on Aug 25, 2014 16:48:48 GMT
I don't know if this will help you with your paper but here is my 2 cents. I work in healthcare if that makes a difference to you. Healthcare is broken, I think that most people will agree. The new guidelines tie reimbursement to performance. Basically, did you get a good review from your patients. I feel like we are in the hospitality industry now. I am a respiratory therapist. I deal with adults who primarily can't breath. They can't breath because they have smoked for many years and now have lung disease. Many continue to smoke despite being told by medical professionals that they need to quit. I am required on initial contact to ask them "Do you smoke?" and if they do follow it up with "Would you like information on quitting?" Most will answer the question simply and we move on. Everyday there is a least one that gets their feathers ruffled and makes a big deal out of my questioning. I remind them that I ask everyone these questions and that the hospital requires me to ask the question. It still pisses them off. The other thing that is tied to hospital reimbursement is readmission to the hospital within 30 days for having difficulty with your breathing. Healthcare providers can not make these people quit smoking and take their medications as ordered. There are also a number of individuals that unfortunately can not afford their medications. They are doing the best they can by trying to stretch their 30 day supply of breathing meds to 60 days. There just aren't a ton of resources out there for people in these situations. That sure is long winded! I hope you find something useful for your paper. I've has a RT accuse me of lying because she didn't believe my asthma is as bad as it is. I've never smoked. Not everyone with lung disease has. I answer the questions but don't like the attitude I've received based on my answers. It happens on both sides.
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Deleted
Posts: 0
Oct 10, 2024 20:29:20 GMT
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Post by Deleted on Aug 25, 2014 16:50:05 GMT
And as for health care it's broken all around. I just don't know it we will ever see meaningful changes because no one wants to do it. The politicians are so far up big pharmas ass it isn't even funny. Along with many other corporations.
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Post by pmm on Aug 25, 2014 17:03:13 GMT
I don't know if this will help you with your paper but here is my 2 cents. I work in healthcare if that makes a difference to you. Healthcare is broken, I think that most people will agree. The new guidelines tie reimbursement to performance. Basically, did you get a good review from your patients. I feel like we are in the hospitality industry now. I am a respiratory therapist. I deal with adults who primarily can't breath. They can't breath because they have smoked for many years and now have lung disease. Many continue to smoke despite being told by medical professionals that they need to quit. I am required on initial contact to ask them "Do you smoke?" and if they do follow it up with "Would you like information on quitting?" Most will answer the question simply and we move on. Everyday there is a least one that gets their feathers ruffled and makes a big deal out of my questioning. I remind them that I ask everyone these questions and that the hospital requires me to ask the question. It still pisses them off. The other thing that is tied to hospital reimbursement is readmission to the hospital within 30 days for having difficulty with your breathing. Healthcare providers can not make these people quit smoking and take their medications as ordered. There are also a number of individuals that unfortunately can not afford their medications. They are doing the best they can by trying to stretch their 30 day supply of breathing meds to 60 days. There just aren't a ton of resources out there for people in these situations. That sure is long winded! I hope you find something useful for your paper. I've has a RT accuse me of lying because she didn't believe my asthma is as bad as it is. I've never smoked. Not everyone with lung disease has. I answer the questions but don't like the attitude I've received based on my answers. It happens on both sides. As an RCP I understand that not all lung disease is caused by smoking. I was focusing on COPDers. There are only a small number of people in this classification that have never smoked. I can see 20+ people in a 12 hours shift and greater than 75% currently smoke or have smoked in the past. I am sorry that you have been put in the position that someone in the medical profession questioned your integrity and honesty. Not all of us are that way. I ask you to consider each interaction with a medical professional a new opportunity to discuss your health care needs with a clean slate. I know for me that I give each person a clean slate every time I see them no matter how they treated me previously.
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Post by pmm on Aug 25, 2014 17:12:43 GMT
Basically, did you get a good review from your patients. I feel like we are in the hospitality industry now. ----------- I want to comment on this... Reimbursements are tied to patient satisfaction, but also outcomes. And yes, we are in the hospitality industry now. More and better patient engagement, equals more and better patient treatment compliance, equals better outcomes, lower costs and higher patient satisfaction. The triple aim. You are very right. I probably shouldn't post after a long day at the hospital. This model is great on paper and will benefit many; unfortunately, there are a number of patients that will not fit into this model because of their lack of finances or their lack of willingness to help take care of themselves.
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Post by compwalla on Aug 25, 2014 18:04:20 GMT
Performance is not just the HCAHPS data. That is only one component influencing reimbursement. Core Measures, HAC measures, and severity-adjusted readmissions are also considered. HCAHPS is probably the component you have the most direct involvement in because you are patient-facing. Readmission measures do consider severity and comorbidities so the lifelong smoker who won't quit counts against the facility less than others. Source: I write health care analytics software for a living.
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Post by jamieson on Aug 25, 2014 20:39:31 GMT
I prefer the option of paying for my own day to day health care needs in cash after having shopped my choices and providers. I would appreciate a tax benefit to doing so. Most practices here won't accept "self-pay" patients. If you become part of a practice and had a catastrophic event, they would have to accept financial responsibility for you. That's a big risk.
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Post by kimpossible on Aug 25, 2014 20:57:13 GMT
We are in the process of getting quotes for a new benefits program. For some of our higher paid employees - their needs are different. They are looking for more tax savings plans.
For my more entry level or lower paid employees, we have to compete with county/state healthcare which is free. They will be less likely to buy into the employers plan when they can get it for free through a local governmental agency.
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Deleted
Posts: 0
Oct 10, 2024 20:29:20 GMT
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Post by Deleted on Aug 25, 2014 21:25:16 GMT
I prefer the option of paying for my own day to day health care needs in cash after having shopped my choices and providers. I would appreciate a tax benefit to doing so. Most practices here won't accept "self-pay" patients. If you become part of a practice and had a catastrophic event, they would have to accept financial responsibility for you. That's a big risk. ive been a cash paying client for 18 years and have never been declined as a patient. I have given birth twice to two high-risk preemies, and had a major repairative knee surgery after a bad fall to the tune of almost a hundred thousand dollars. I have a GP and an endocrinologist. My son has been a regular at Vanderbilt Neuro for his whole life. We always write them a check. In the next paragraph after the one you quoted I said I would like the option to pay for a catastrophic event only insurance plan. I'm not asking anyone to take a risk. I'm sure some clueless practices somewhere don't accept cash pay clients but that's their short-sightedness. There are plenty who do...and it's to their benefit. Concierge medicine. For the sick and the healthy. And those who don't want to be jacked around by insurance companies.
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Post by Regina Phalange on Aug 25, 2014 21:40:42 GMT
Most practices here won't accept "self-pay" patients. If you become part of a practice and had a catastrophic event, they would have to accept financial responsibility for you. That's a big risk. ive been a cash paying client for 18 years and have never been declined as a patient. I have given birth twice to two high-risk preemies, and had a major repairative knee surgery after a bad fall to the tune of almost a hundred thousand dollars. I have a GP and an endocrinologist. My son has been a regular at Vanderbilt Neuro for his whole life. We always write them a check. In the next paragraph after the one you quoted I said I would like the option to pay for a catastrophic event only insurance plan. I'm not asking anyone to take a risk. I'm sure some clueless practices somewhere don't accept cash pay clients but that's their short-sightedness. There are plenty who do...and it's to their benefit. Concierge medicine. For the sick and the healthy. And those who don't want to be jacked around by insurance companies. You do realize that the vast majority of Americans can't afford to pay their own preventative care bills, let alone a six figure procedure. It's kind of why we have insurance in the first place. If you've been a cash paying client anyway, then aren't you getting what you want already?
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Deleted
Posts: 0
Oct 10, 2024 20:29:20 GMT
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Post by Deleted on Aug 25, 2014 21:51:39 GMT
ive been a cash paying client for 18 years and have never been declined as a patient. I have given birth twice to two high-risk preemies, and had a major repairative knee surgery after a bad fall to the tune of almost a hundred thousand dollars. I have a GP and an endocrinologist. My son has been a regular at Vanderbilt Neuro for his whole life. We always write them a check. In the next paragraph after the one you quoted I said I would like the option to pay for a catastrophic event only insurance plan. I'm not asking anyone to take a risk. I'm sure some clueless practices somewhere don't accept cash pay clients but that's their short-sightedness. There are plenty who do...and it's to their benefit. Concierge medicine. For the sick and the healthy. And those who don't want to be jacked around by insurance companies. You do realize that the vast majority of Americans can't afford to pay their own preventative care bills, let alone a six figure procedure. It's kind of why we have insurance in the first place. If you've been a cash paying client anyway, then aren't you getting what you want already? Exactly. This would bankrupt everyone I know.
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Post by anxiousmom on Aug 25, 2014 22:01:24 GMT
And today, I am not the one to ask. I just got my new bill for this year and it has gone to a monthly payment of $560/month-and that is just for me. I double checked, and in the last four years, my insurance has more than doubled in cost.
Why? Are the lawyers getting paid for malpractice? Is that I am paying for those who aren't? Am I paying to cover benefits that I don't use (yes-for one, I don't need maternity care anymore.) I don't know and I don't know the answers, I just know that I am paying a shitload of money for insurance and am at the point where I simply can't pay that amount anymore.
The whole thing is making me sick to my stomach.
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Post by jamieson on Aug 25, 2014 22:07:26 GMT
ive been a cash paying client for 18 years and have never been declined as a patient. I have given birth twice to two high-risk preemies, and had a major repairative knee surgery after a bad fall to the tune of almost a hundred thousand dollars. I have a GP and an endocrinologist. My son has been a regular at Vanderbilt Neuro for his whole life. We always write them a check. In the next paragraph after the one you quoted I said I would like the option to pay for a catastrophic event only insurance plan. I'm not asking anyone to take a risk. I'm sure some clueless practices somewhere don't accept cash pay clients but that's their short-sightedness. There are plenty who do...and it's to their benefit. Concierge medicine. For the sick and the healthy. And those who don't want to be jacked around by insurance companies. You do realize that the vast majority of Americans can't afford to pay their own preventative care bills, let alone a six figure procedure. It's kind of why we have insurance in the first place. If you've been a cash paying client anyway, then aren't you getting what you want already? Clueless practices? That's a laugh. We're talking the premiere practices of the entire country, if not world. So, say you ran into a situation that would cost upwards of $300,000. Would you still be equipped to pay out of pocket? You need to have a backup guarantor (insurance) for these potential costs in this part of the country. No sane practice would knowingly incur such risk upfront. We have a major shortage of primary care docs in our state, and have for decades. It's too expensive to pay for malpractice insurance and other costs of practicing medicine. By the way, I'm impressed that you are able to write checks for such significant amounts instead of just paying insurance premiums. Have you done a cost analysis of what you might have saved doing the latter?
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Post by jamieson on Aug 25, 2014 22:14:14 GMT
I don't need or want a bunch of paperwork, government blah blah blah. Simple is way better, in my opinion. But I suppose that would lessen the need for coders...so sorry about that. What alternate universe are you finding these "simple" providers in? I'm amazed that a neurologist practicing at Vanderbilt would agree to take your child on as a patient. What if he were to have an aneurism or need a million dollar brain surgery? I agree that simple is better, but to some extent you get what you pay for.
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lindy
Shy Member
Posts: 29
Jun 26, 2014 0:15:26 GMT
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Post by lindy on Aug 26, 2014 1:38:22 GMT
And as for health care it's broken all around. I just don't know it we will ever see meaningful changes because no one wants to do it. The politicians are so far up big pharmas ass it isn't even funny. Along with many other corporations. There are some major initiatives happening at the primary care level that will produce meaningful outcomes-based data in the next two years. Insurance companies are engaged in one of the biggest pilots that involves statewide-span in five states of varying demographics/population models. Once the proof is shown in the data and actual lives saved (and ED visits avoided) are calculated, everyone is going to have to come along for the ride. Medicare is starting to make the turn -- just last week they announced they would pay a care management fee for practices actively/proactively managing care for Medicare benes. Big dollars on that one. Active care management (not case management, not care coordination) is a proven winner for patients. I regularly have contact with physicians, PAs, APRNs, QI directors, data analysts and others in health care who see the tide turning. It's going to happen. It's just going to take time because it's a HUGE undertaking. Sadly, one of the key big thinkers behind the Triple Aim that megop mentioned is Don Berwick, who resigned from overseeing CMS rather than go through a grueling confirmation ordeal with Congress. We could be quite a few years ahead on this curve if he were still in a position to move policy at CMS.
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Post by megop on Aug 26, 2014 2:45:31 GMT
And as for health care it's broken all around. I just don't know it we will ever see meaningful changes because no one wants to do it. The politicians are so far up big pharmas ass it isn't even funny. Along with many other corporations.
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This is most certainly not true. If you would consider what has been handed down from ACA requirements, there are most certainly health systems that wants to, and are doing so.
And Lindy, Don Berwick is a rockstar! He's still making great influence, especially within the ACO space most certainly.
Regarding the "cash pay" aspect. What you are seeing now and more in the future is innovation of health care delivery. You will have more choice. There will be more and more retail health care delivery for routine and preventative care. There's a caveat to that a bit though, because as more and more are staying healthy, have better access, it means less census in trauma centers, which must be maintained for crisis. Less census means, if you do have an unfortunate accident, true trauma, may cost more, but preventative care, by and large, is very much beginning to become more controlled.
I think people had a notion that the ACA would merely be funding health care insurance within the fee-for-service model. It simply isn't so.
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Post by megop on Aug 26, 2014 2:50:04 GMT
Practices who don't accept cash clients, aren't "clueless," the innovation and choice of delivery is much, much more free and open then that. Delivery doesn't happen in a once size fits all vacuum most certainly. And you will find more and more innovative options as t things change.
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