8 ms·

At my wife's practice they employ two people full time just to do insurance authorizations. edit: actually one of those people does verification (checking to s

by conorh 8y ago

At my wife's practice they employ two people full time just to do insurance authorizations. edit: actually one of those people does verification (checking to see what insurance patients have, what is covered, and estimate what they will owe) and the other person just does authorization (getting the insurance company to approve the procedure)

Spooky23 8y ago
I use my GP as the example. It's a fun tale. When he was in a partnership with 4 other doctors, he started with a paper system. They had two receptionists, and three clerk/billers. I used to help him out with some tech stuff. They implemented an EMR prior to the Medicare mandate, with an ROI driven by dropping 2.5 FTE. They ended up dropping the clerks and hiring IT expertise at a cost 50% higher than the clerks. Medicare mandate came, and the EMR didn't meet requirements and had to be replaced. They joined a larger physician group, and paid for 0.2 IT FTE. But they had to hire two PAs and a NP to drive revenue and now have 6 clerical people. (+1 from paper) Now they were acqui-hired by a sprawling medical network. Their cost center became a dumping ground for redundant hospital staff and they have 10 non-medical people (+5 from paper-based, independent practice). Now they run two EMRs and are transitioning to a third. They lost the ability to collect money at the counter, and now bill for every co-pay and lab. (My wife received a paper bill for $0.78 for a pregnancy test via postal mail) In short, between bad policy, government encouragement of cartel behavior, and general stupid big company bullshit my doctor went from a progressive medical practice with talented doctors and medical staff to a bloated sales funnel for unnecessary specialist care over the course of about 15 years.
- nojvek 8y ago
  Granted America’s love for ACA is sound. Poor people shouldn’t have to forgo medical procedures because they are poor and die. But the execution is a giant shit show. Trump abandoned it but I highly doubt anything will replace it. If Trump doesn’t cause another financial disaster, there are chances the next President can make some headway to get US a sane healthcare system. It’s so ripe for disruption. Amazon’s insane valuation I bet is also based on the fact that they are going after Healthcare. If they can bring Amazon level service and convinience we may turn the tables. Personal preference but even though I don’t support making Bezos accumulate so much wealth, Amazon prime service is unbeatable. It’s just so darn convenient. I don’t see any close alternative.
fma 8y ago
What's interesting is I heard that if you pay cash, up front the doctor's office will charge you less. So I had this appointment (forgot for what) and they gave an estimate with my insurance. I asked...if I wanted to pay for all of it right now, how much would it cost...and she said it would be the same. Of course I said ok, fine...run it through insurance. That year I wasn't going to meet deductible so I had no incentive to go through insurance.
- randysavage 8y ago
  My wife needed an MRI last year. The hospital quoted us $4000 as self-pay, but would knock it down to $2000 if we paid cash up front. This was late December, so we picked up insurance through the marketplace and she had the MRI done in January, billed to insurance at $250. This still boggles my mind... I understand the insurance provider negotiates bulk rates, but we were paying up front, in cash, and were still quoted 8x the insurance price.
  - deathanatos 8y ago
    I've had a doctors office tell me that it was literally impossible for them to estimate, let alone quote me, a price for how much my visit would cost. (My finger was infected. I needed a week of antibiotics. That was it.)
    - pm90 8y ago
      Yup. Same experience here... had to have an emergency appendectomy and my biggest worry wasn't the operation itself but its cost. I persisted in asking the doctors for an estimate, but they wouldn't budge. Neither would the clerical staff... which made 0 sense to me. Its not the first operation they have done, I just wanted rough figures (i.e. 5k? 50k? 500k?) but they wouldn't give me that either. Final billing: 55k in total, but because of insurance I paid about 5k. Which still left me wondering... what did people without insurance do? How could they possibly pay that much money, if they couldn't even get insurance?
      - 8y ago
maxerickson 8y ago
For how many doctors? Ideally we'd be in a situation where your wife had time to do much of that stuff herself, so that she was cutting prices to attract patient load instead of paying 2 people to help increase the time available to serve patient load.
specialist 8y ago
I usually link to this chart whenever this topic comes up. Growth of Physicians & Administrators 1970-2009 http://gomerblog.com/2015/12/healthcare-costs/ http://gomerblog.com/2015/12/healthcare-costs/ TL;DR: Our overhead is ridiculous. Any one who has worked inside the beast knows single payer is the correct next step, followed by replacing fee-for-service (treating disease) with capitation (incentivizing wellness). Not a big mystery. Just look around at what other jurisdictions are doing, copy what works.
- ryandrake 8y ago
  Single payer will never be implemented in the US without massive political and social change. It is ideologically opposed here in at least three ways: 1. Healthcare is a luxury that must be earned. Giving it away to people who don’t deserve it is categorically bad. 2. Jobs are important. Universal healthcare would mean fewer people working in the various health industry bureaucracies, which is categorically bad. 3. Business is important. Universal healthcare would kill or cripple health insurance business which is categorically bad.
  - specialist 8y ago
    If I believed that, I wouldn't get out of bed every day. A large part of choosing action (activism, startups, remodeling, etc) is suspending disbelief. I have friends working on single payer. I just attended a policy planning event last night. To your point, the outlook is pretty bleak. I give money. I've also decided to also give time and labor. Meanwhile, I've come up with a Plan B, a way to hack the current system to expand affordable coverage. Early feedback from my policy and industry friends has been very positive (which is a novel experience for me).
- spydum 8y ago
  That entire site seems clearly satire.. not sure if you were being serious or what?
  - specialist 8y ago
    Ugh. Content farm. I just grabbed the first hit. My bad. https://duckduckgo.com/?q=growth+of+physicians+and+administrators https://duckduckgo.com/?q=growth+of+physicians+and+administr... Maybe this instance is more reputable? https://fee.org/articles/the-chart-that-could-undo-the-us-healthcare-system/ https://fee.org/articles/the-chart-that-could-undo-the-us-he... For future, I'll try to find the original cite. I'm gonna be super chagrinned, embarrassed if I've been forwarding "fake news". Good eye. Thank you.

by conorh 8y ago

Spooky23 8y ago

I use my GP as the example. It's a fun tale. When he was in a partnership with 4 other doctors, he started with a paper system. They had two receptionists, and three clerk/billers. I used to help him out with some tech stuff. They implemented an EMR prior to the Medicare mandate, with an ROI driven by dropping 2.5 FTE. They ended up dropping the clerks and hiring IT expertise at a cost 50% higher than the clerks. Medicare mandate came, and the EMR didn't meet requirements and had to be replaced. They joined a larger physician group, and paid for 0.2 IT FTE. But they had to hire two PAs and a NP to drive revenue and now have 6 clerical people. (+1 from paper) Now they were acqui-hired by a sprawling medical network. Their cost center became a dumping ground for redundant hospital staff and they have 10 non-medical people (+5 from paper-based, independent practice). Now they run two EMRs and are transitioning to a third. They lost the ability to collect money at the counter, and now bill for every co-pay and lab. (My wife received a paper bill for $0.78 for a pregnancy test via postal mail) In short, between bad policy, government encouragement of cartel behavior, and general stupid big company bullshit my doctor went from a progressive medical practice with talented doctors and medical staff to a bloated sales funnel for unnecessary specialist care over the course of about 15 years.

nojvek 8y ago
Granted America’s love for ACA is sound. Poor people shouldn’t have to forgo medical procedures because they are poor and die. But the execution is a giant shit show. Trump abandoned it but I highly doubt anything will replace it. If Trump doesn’t cause another financial disaster, there are chances the next President can make some headway to get US a sane healthcare system. It’s so ripe for disruption. Amazon’s insane valuation I bet is also based on the fact that they are going after Healthcare. If they can bring Amazon level service and convinience we may turn the tables. Personal preference but even though I don’t support making Bezos accumulate so much wealth, Amazon prime service is unbeatable. It’s just so darn convenient. I don’t see any close alternative.

fma 8y ago

What's interesting is I heard that if you pay cash, up front the doctor's office will charge you less. So I had this appointment (forgot for what) and they gave an estimate with my insurance. I asked...if I wanted to pay for all of it right now, how much would it cost...and she said it would be the same. Of course I said ok, fine...run it through insurance. That year I wasn't going to meet deductible so I had no incentive to go through insurance.

randysavage 8y ago
My wife needed an MRI last year. The hospital quoted us $4000 as self-pay, but would knock it down to $2000 if we paid cash up front. This was late December, so we picked up insurance through the marketplace and she had the MRI done in January, billed to insurance at $250. This still boggles my mind... I understand the insurance provider negotiates bulk rates, but we were paying up front, in cash, and were still quoted 8x the insurance price.
- deathanatos 8y ago
  I've had a doctors office tell me that it was literally impossible for them to estimate, let alone quote me, a price for how much my visit would cost. (My finger was infected. I needed a week of antibiotics. That was it.)
  - pm90 8y ago
    Yup. Same experience here... had to have an emergency appendectomy and my biggest worry wasn't the operation itself but its cost. I persisted in asking the doctors for an estimate, but they wouldn't budge. Neither would the clerical staff... which made 0 sense to me. Its not the first operation they have done, I just wanted rough figures (i.e. 5k? 50k? 500k?) but they wouldn't give me that either. Final billing: 55k in total, but because of insurance I paid about 5k. Which still left me wondering... what did people without insurance do? How could they possibly pay that much money, if they couldn't even get insurance?
    - 8y ago

maxerickson 8y ago

For how many doctors? Ideally we'd be in a situation where your wife had time to do much of that stuff herself, so that she was cutting prices to attract patient load instead of paying 2 people to help increase the time available to serve patient load.

specialist 8y ago

I usually link to this chart whenever this topic comes up. Growth of Physicians & Administrators 1970-2009 http://gomerblog.com/2015/12/healthcare-costs/ http://gomerblog.com/2015/12/healthcare-costs/ TL;DR: Our overhead is ridiculous. Any one who has worked inside the beast knows single payer is the correct next step, followed by replacing fee-for-service (treating disease) with capitation (incentivizing wellness). Not a big mystery. Just look around at what other jurisdictions are doing, copy what works.

ryandrake 8y ago
Single payer will never be implemented in the US without massive political and social change. It is ideologically opposed here in at least three ways: 1. Healthcare is a luxury that must be earned. Giving it away to people who don’t deserve it is categorically bad. 2. Jobs are important. Universal healthcare would mean fewer people working in the various health industry bureaucracies, which is categorically bad. 3. Business is important. Universal healthcare would kill or cripple health insurance business which is categorically bad.
- specialist 8y ago
  If I believed that, I wouldn't get out of bed every day. A large part of choosing action (activism, startups, remodeling, etc) is suspending disbelief. I have friends working on single payer. I just attended a policy planning event last night. To your point, the outlook is pretty bleak. I give money. I've also decided to also give time and labor. Meanwhile, I've come up with a Plan B, a way to hack the current system to expand affordable coverage. Early feedback from my policy and industry friends has been very positive (which is a novel experience for me).
spydum 8y ago
That entire site seems clearly satire.. not sure if you were being serious or what?
- specialist 8y ago
  Ugh. Content farm. I just grabbed the first hit. My bad. https://duckduckgo.com/?q=growth+of+physicians+and+administrators https://duckduckgo.com/?q=growth+of+physicians+and+administr... Maybe this instance is more reputable? https://fee.org/articles/the-chart-that-could-undo-the-us-healthcare-system/ https://fee.org/articles/the-chart-that-could-undo-the-us-he... For future, I'll try to find the original cite. I'm gonna be super chagrinned, embarrassed if I've been forwarding "fake news". Good eye. Thank you.