5 ms·

>The crux is hospitals and doctors don’t want their pay cut Whether hospitals and doctors are really charging fair prices aside can't cost reductions also be a

>The crux is hospitals and doctors don’t want their pay cut Whether hospitals and doctors are really charging fair prices aside can't cost reductions also be accomplished by cutting out middlemen? I think there's going to be far more pushback from those rent seekers than the service providers.

toomuchtodo 7y ago
Of course. Current middlemen are around 9% of healthcare expenditures.
gremlinsinc 7y ago
The mentioned 15-20% off the top for insurance, but the insurance/billing industry is two sided, wouldn't there also be a ton of administrative savings by having a fraction of the 'billing/coders'? They'd only have to deal w/ the U.S. government which isn't going to be as nitpicky and litigious over every little line item.
- nradov 7y ago
  On the contrary. Medicare is extremely nitpicky on every claim line item.
  - gremlinsinc 7y ago
    Only because they can be, if hospitals and law-makers meet in the middle come up w/ across the industry iron-clad rates for services, or hell -- what if hospitals just get a flat average monthly lump sum -- no piecemeal at all, just based on # of patients that go through their door in a month? Dr's get x% based on patients they saw + hours booked in the OR. Hospital administrators would have pay caps of 1 million per year. Hospitals that struggle could get grants and loans while the system corrects and adjusts to pay them more so they meet their budget constraints.
    - nradov 7y ago
      Yes capitation is already being tried in some areas as one approach to shifting the market from a fee-for-service model to value-based care. However provider organizations still struggle with it because most lack the data, tools, and expertise to properly price the risk. Medicare administrators and lawmakers already do set iron-clad rates for service. The rates are relatively low, which is why there's a shortage of doctors willing to treat Medicare patients. And being nitpicky on claims isn't so much a matter of pricing. Instead the insurers are trying to prevent waste, fraud, and abuse.
  - gremlinsinc 7y ago
    An option I've thought of btw -- also is what about hospitals BEING the insurer? For instance, say they simply charged 6% of income for insurance. You'd signup through your local/favorite nearby hospital -- and pay your 6% of salary (nothing if you are in poverty), the hospital benefits because they have recurring monthly income that they can count on for budgets and things. When you travel your hospital pays other doctors and hospitals. Your hospital also pays your primary doctor, and other professionals as needed. This would basically cut out the insurer middleman, still leave it fairly privatized, but also lower the need for billers. Hospitals aren't going to gouge prices when they're the ones paying the bill right? Government could also give grants/subsidies to help w/ the system as needed or tax relief. I think fair % might be 2% per 30k annual salary upto 10% of income.
    - kwhitefoot 7y ago
      Apart from your idea of signing up to a specific hospital this is how systems like the NHS work. They are funded from a specific tax in the UK and general taxation in some other countries. They either don't bill anyone for the care they provide and have no bureaucratic machinery for doing so, like the UK NHS or a here in Norway we pay a sort of co-pay for each doctor or hospital visit but it is capped at quite low levels, a couple of hundred dollars a year. And it is not related to the fine details of the treatment you have received so again there is very little bureaucracy.
    - nradov 7y ago
      Kaiser Permanente already acts as both a provider and payer in a single organization. The rest of the industry is gradually moving toward that model. But patients probably won't pay based on an income percentage.

toomuchtodo 7y ago

Of course. Current middlemen are around 9% of healthcare expenditures.

gremlinsinc 7y ago

The mentioned 15-20% off the top for insurance, but the insurance/billing industry is two sided, wouldn't there also be a ton of administrative savings by having a fraction of the 'billing/coders'? They'd only have to deal w/ the U.S. government which isn't going to be as nitpicky and litigious over every little line item.

nradov 7y ago
On the contrary. Medicare is extremely nitpicky on every claim line item.
- gremlinsinc 7y ago
  Only because they can be, if hospitals and law-makers meet in the middle come up w/ across the industry iron-clad rates for services, or hell -- what if hospitals just get a flat average monthly lump sum -- no piecemeal at all, just based on # of patients that go through their door in a month? Dr's get x% based on patients they saw + hours booked in the OR. Hospital administrators would have pay caps of 1 million per year. Hospitals that struggle could get grants and loans while the system corrects and adjusts to pay them more so they meet their budget constraints.
  - nradov 7y ago
    Yes capitation is already being tried in some areas as one approach to shifting the market from a fee-for-service model to value-based care. However provider organizations still struggle with it because most lack the data, tools, and expertise to properly price the risk. Medicare administrators and lawmakers already do set iron-clad rates for service. The rates are relatively low, which is why there's a shortage of doctors willing to treat Medicare patients. And being nitpicky on claims isn't so much a matter of pricing. Instead the insurers are trying to prevent waste, fraud, and abuse.
- gremlinsinc 7y ago
  An option I've thought of btw -- also is what about hospitals BEING the insurer? For instance, say they simply charged 6% of income for insurance. You'd signup through your local/favorite nearby hospital -- and pay your 6% of salary (nothing if you are in poverty), the hospital benefits because they have recurring monthly income that they can count on for budgets and things. When you travel your hospital pays other doctors and hospitals. Your hospital also pays your primary doctor, and other professionals as needed. This would basically cut out the insurer middleman, still leave it fairly privatized, but also lower the need for billers. Hospitals aren't going to gouge prices when they're the ones paying the bill right? Government could also give grants/subsidies to help w/ the system as needed or tax relief. I think fair % might be 2% per 30k annual salary upto 10% of income.
  - kwhitefoot 7y ago
    Apart from your idea of signing up to a specific hospital this is how systems like the NHS work. They are funded from a specific tax in the UK and general taxation in some other countries. They either don't bill anyone for the care they provide and have no bureaucratic machinery for doing so, like the UK NHS or a here in Norway we pay a sort of co-pay for each doctor or hospital visit but it is capped at quite low levels, a couple of hundred dollars a year. And it is not related to the fine details of the treatment you have received so again there is very little bureaucracy.
  - nradov 7y ago
    Kaiser Permanente already acts as both a provider and payer in a single organization. The rest of the industry is gradually moving toward that model. But patients probably won't pay based on an income percentage.