3 ms·

> The basic accounting problem for hospitalists is that they are not a profit center. That is, when they treat patients, the amount a hospital can bill Medicare

> The basic accounting problem for hospitalists is that they are not a profit center. That is, when they treat patients, the amount a hospital can bill Medicare and insurance companies is typically less than what the hospital must pay them. The opposite is true for other specialists, like surgeons. The rest of the article focused on peoples' emotional reactions, but that paragraph is key. Medicare, Medicaid, and the insurance companies will pay more than enough for tests and surgeries, but not for the diagnoses and treatments that hospitalists and GP's perform themselves. So the folks running the hospital budgets are naturally trying to change the model so that the hospitalists quickly refer patients to the more profitable departments. The only actor able to change this model is the US Congress, which makes the legislation that sets the Medicare and Medicaid reimbursement rates. There were major improvements with the ACA/Obamacare, but it's a dysfunctional system that can only be fixed by an even more dysfunctional system.

dmix 11y ago
> it's a dysfunctional system that can only be fixed by an even more dysfunctional system Indeed, the health industry is probably one of the worst places for capitalism/markets to rule. Not that I believe unionization and a further regulated industry is the answer either. While I'll defend markets to death in most other areas, there are admittedly a few industries where it the corrective benefits of competition/market pricing just doesn't make sense. Healthcare is the perfect example of where abiding strictly by these incentives create perverse side-effects which ultimately create a net-negative environment for the industry and the consumers. Living in Canada has given me perspective on this matter, where our public health insurance system functions very well without markets. It's a shame politics drives everyone to think they should be purists on each matter. Sometimes the data and emotional experience will demonstrates otherwise. Or worse, politics often create a muddled middle-of-the-road compromise, easily manipulated by either-side's special interests. It takes quite a bit of self-delusion to believe a particular economic theory should be applied uniformly everywhere when results show otherwise.

dmix 11y ago

> it's a dysfunctional system that can only be fixed by an even more dysfunctional system Indeed, the health industry is probably one of the worst places for capitalism/markets to rule. Not that I believe unionization and a further regulated industry is the answer either. While I'll defend markets to death in most other areas, there are admittedly a few industries where it the corrective benefits of competition/market pricing just doesn't make sense. Healthcare is the perfect example of where abiding strictly by these incentives create perverse side-effects which ultimately create a net-negative environment for the industry and the consumers. Living in Canada has given me perspective on this matter, where our public health insurance system functions very well without markets. It's a shame politics drives everyone to think they should be purists on each matter. Sometimes the data and emotional experience will demonstrates otherwise. Or worse, politics often create a muddled middle-of-the-road compromise, easily manipulated by either-side's special interests. It takes quite a bit of self-delusion to believe a particular economic theory should be applied uniformly everywhere when results show otherwise.