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If they can't predict a complication, shouldn't they be setting an ahead of time fee that will on average cover it? Why does the provider get to push the unpred

If they can't predict a complication, shouldn't they be setting an ahead of time fee that will on average cover it? Why does the provider get to push the unpredictable risk onto the patient who has less control than they do? Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.

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riceart 3y ago
> Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly. That’s what you think is the common root cause of complications? You clearly are not interested in a productive discussion. As for a fee for unpredictable occurrences - that’s what insurance is.
- maxerickson 3y ago
  If the amount to bill the patient's insurance is determined after the complication, it's not an unpredictable risk, it's a fact. If it can't be predicted, then it more or less exists for each procedure, but that isn't reflected in the cost, the patient that has the bad experience gets charged extra for it.
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  - riceart 3y ago
    Insurance exists to cover losses from unexpected events. Medical complications are unexpected events. Your hungover surgeon is a bullshit strawman - most complications have nothing to do with provider malice or incompetence. Again since that seems to be the angle you are starting with you clearly have no interest in a grown up discussion or too ignorant and also full of hubris to understand any of this (which fits in perfectly well on this site). If you throw a massive clot after a surgery and stroke out who’s fault was that if all the standard protocols for clot prevention were followed. Maybe you’re a smoker (or not) and 5 years later that unknown cancer will finally declare itself. > more or less exists for each procedure This is extremely misleading as it does not exist in any meaningful level of risk across the entire patient population.
    - bandrami 3y ago
      I think you're getting hung up on a joke about the hung-over doctor. The problem is that whatever the complication is, it should be amortized over all the deliveries of that treatment, not the one case where it happens to occur.
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    - maxerickson 3y ago
      If they can predict the complication, they can bill for it ahead of time. It is all insurance in the end, but the incentives created by pushing the providers to bill ahead are better than the ones created by letting them bill for what they do.
HDThoreaun 3y ago
I agree the fee for service is a bad model. Capitated payouts have seen a lot of success in Medicare and kaiser Permanente. But that's just how it works today.
devilbunny 3y ago
FWIW, it's not the surgeon, it's the hospital. Surgeons are paid a fee for each surgery that is a 90-day global fee: any postop appointments, any re-operations, any hospital visits within that 90 days get not a nickel.

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riceart 3y ago

> Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly. That’s what you think is the common root cause of complications? You clearly are not interested in a productive discussion. As for a fee for unpredictable occurrences - that’s what insurance is.

maxerickson 3y ago
If the amount to bill the patient's insurance is determined after the complication, it's not an unpredictable risk, it's a fact. If it can't be predicted, then it more or less exists for each procedure, but that isn't reflected in the cost, the patient that has the bad experience gets charged extra for it.
- deleted 3y ago
  [deleted]
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- riceart 3y ago
  Insurance exists to cover losses from unexpected events. Medical complications are unexpected events. Your hungover surgeon is a bullshit strawman - most complications have nothing to do with provider malice or incompetence. Again since that seems to be the angle you are starting with you clearly have no interest in a grown up discussion or too ignorant and also full of hubris to understand any of this (which fits in perfectly well on this site). If you throw a massive clot after a surgery and stroke out who’s fault was that if all the standard protocols for clot prevention were followed. Maybe you’re a smoker (or not) and 5 years later that unknown cancer will finally declare itself. > more or less exists for each procedure This is extremely misleading as it does not exist in any meaningful level of risk across the entire patient population.
  - bandrami 3y ago
    I think you're getting hung up on a joke about the hung-over doctor. The problem is that whatever the complication is, it should be amortized over all the deliveries of that treatment, not the one case where it happens to occur.
    - deleted 3y ago
      [deleted]
  - maxerickson 3y ago
    If they can predict the complication, they can bill for it ahead of time. It is all insurance in the end, but the incentives created by pushing the providers to bill ahead are better than the ones created by letting them bill for what they do.

HDThoreaun 3y ago

I agree the fee for service is a bad model. Capitated payouts have seen a lot of success in Medicare and kaiser Permanente. But that's just how it works today.

devilbunny 3y ago

FWIW, it's not the surgeon, it's the hospital. Surgeons are paid a fee for each surgery that is a 90-day global fee: any postop appointments, any re-operations, any hospital visits within that 90 days get not a nickel.