2 ms·

Thank you for sharing this, really helpful to hear from someone inside the industry and of course, the issue is super nuanced and complex. I just wonder if/when

Thank you for sharing this, really helpful to hear from someone inside the industry and of course, the issue is super nuanced and complex. I just wonder if/when something will give in the U.S. But you said something that stood out - "Everyone has their finger in the pot trying to get paid for their services in a world of increasingly small reimbursements." Given the rising prices, why isn't the pot getting bigger? What do you think of Epic systems and EHR stuff?

pc86 5y ago
I have friends that work at Epic but I don't do a lot on the EHR side. I will say I went several years ca. 2010-2019 or so without utilizing healthcare at all, and went from having doctors laugh at me when I asked for my chart and telling me that I wasn't allowed to see it from being able to log in to my doctor's portal and see my actual Epic chart, complete with their shorthand, typos, etc. The first time I logged in, after the initial shock, I was able to correct two errors in my medical history from when I was in HS. So from a consumer standpoint I am 110% pro-EHR. I think the pot is getting bigger but it's getting bigger for gigantic organizations like Kaiser (not calling them out specifically but it's a name everyone knows). Someone pointed out, either here or in the tweet thread, that the 2011-2020 price increases are just going to Stanford. The physicians don't see any of that because they have their own reimbursement, and the patient gets their own bill. When we ran billing in-house it was not uncommon for patients to call us with billing issues because they didn't understand (nor should they have had to) that our radiology service bill was separate from the hospital. Which was separate from the anesthesiologist. Which was separate from the lab. Etc. I see the pot getting bigger mainly for insurance companies, and large hospital systems, in that order. Some docs in some specialties are doing as well or better than they were ten years ago but a lot of the primary care specialties just get whatever the Medicare reimbursement is and don't have any control over it. Insurance companies will pay them whatever they decide to pay them. So short of increasing the cash price on that minority patients, all of whom are going to be very price sensitive, the independent docs and small practices can't do much to move the lever. Healthcare software vendors seem to be making out like bandits because their clients are typically the large systems and insurers who are flush with cash.

pc86 5y ago

I have friends that work at Epic but I don't do a lot on the EHR side. I will say I went several years ca. 2010-2019 or so without utilizing healthcare at all, and went from having doctors laugh at me when I asked for my chart and telling me that I wasn't allowed to see it from being able to log in to my doctor's portal and see my actual Epic chart, complete with their shorthand, typos, etc. The first time I logged in, after the initial shock, I was able to correct two errors in my medical history from when I was in HS. So from a consumer standpoint I am 110% pro-EHR. I think the pot is getting bigger but it's getting bigger for gigantic organizations like Kaiser (not calling them out specifically but it's a name everyone knows). Someone pointed out, either here or in the tweet thread, that the 2011-2020 price increases are just going to Stanford. The physicians don't see any of that because they have their own reimbursement, and the patient gets their own bill. When we ran billing in-house it was not uncommon for patients to call us with billing issues because they didn't understand (nor should they have had to) that our radiology service bill was separate from the hospital. Which was separate from the anesthesiologist. Which was separate from the lab. Etc. I see the pot getting bigger mainly for insurance companies, and large hospital systems, in that order. Some docs in some specialties are doing as well or better than they were ten years ago but a lot of the primary care specialties just get whatever the Medicare reimbursement is and don't have any control over it. Insurance companies will pay them whatever they decide to pay them. So short of increasing the cash price on that minority patients, all of whom are going to be very price sensitive, the independent docs and small practices can't do much to move the lever. Healthcare software vendors seem to be making out like bandits because their clients are typically the large systems and insurers who are flush with cash.