My mother and I have used the same doctor for years. Yesterday, we each got a letter that this doctor was moving to a new address. My letter said, "I sincerely hope you choose to make this move with me". Mom's was a patient termination letter - she's 65 and has since confirmed with Mercy that all patients over 65 (Medicare age) were sent the termination letter instead. It encourages them to choose from a list of other Mercy doctors. Does anyone have any insight on why a doctor, or Mercy, would choose to handle this situation like this? It just doesn't seem right to me. Oh, from the letter she received yesterday, the termination is effective March 31.

If I had to hazard a guess, it'd have to do with Medicare. Medicare is a bit more of a hassle to deal with, and may not pay out as much as other providers.

If I had to hazard a guess, it'd have to do with Medicare. Medicare is a bit more of a hassle to deal with, and may not pay out as much as other providers.

yep this .. more and more doctors are no longer taking medicare patients

Reading the title I thought he was killing off his older patients before he moves.

Yeah, everything I've read suggests doctors are just getting fed up with ever decreasing Medicare reimbursements and all the hassle factor associated with them, so they just bail on the whole thing. More broadly, looks like more and more doctors are starting to just bail on their whole practice, retiring early and shutting things down between malpractice insurance premiums and government presence..

And I suspect its' gonna get a lot worse before it gets better.

It sounds like Obamacare is accelerating the segregation of Americans into health care "haves" and "have nots." The former have private insurance and are seen by better doctors at private practices, and the latter have Medicare and are seen by not-as-good doctors who are affiliated with hospitals.

I don't mean to disparage doctors in hospitals, but if I'm good and I can earn more money by striking out on my own, then I will. If I'm not as good, then I'll remain behind as a hospital staff physician and be paid less.

Just returned home from taking my 91-yr-old mom to her doctor. He was going on and on about the paperwork and DETAILS now required by Medicare...and that it did not matter whether or not we had supplemental ins. or even if we were going to pay for her insulin ourselves (which we have to do, as the kind she uses isn't covered by Medicare--in spite of what those ads on TV say!). He said the rules have changed greatly, namely because people were wanting a "double" rx for their meds, so they would only have to do one co-pay. Both the ins. cos & the feds were drawing a line and saying "no" to that approach.

Fortunately, he is still treating older patients, but he is planning on retiring in 2014!

The problem is part doctors and part government.

We've all seen news stories about (bad) doctors billing medicare / medicade billions in fraudulent charges for test and procedures that never happened. So the government rolls out with more regulations and more guidelines that further pushes away good doctors because the amount of staff they have to hire and the amount of time they have to commit to filling out the paperwork.

This is from first page google search but we've all seen the same ones in the metro every year.

50 million in fraud
http://www.upi.com/Top_News/US/2013/03/15/Fla-doctor-gets-prison-for-Medicare-fraud/UPI-91551363391854/

17.3 million in fraud
http://www.justice.gov/opa/pr/2012/December/12-crm-1498.html

375million in fraud
http://articles.latimes.com/2012/feb/29/nation/la-na-medicare-fraud-20120229


Can I say I blame Mercy - no
Can i say i blame good doctors for being fed up - no
Can i say i blame the government for trying to prevent fraud - no and im actually ecstatic that they are atleast trying to eliminate people who steal from the tax payer and are actually doing a good job at it.

But if im a good, ethical doctor who is in high demand i would want to move on myself.

[QUOTE=WilliamTell;630770]
Can I say I blame Mercy - no
Can i say i blame good doctors for being fed up - no
Can i say i blame the government for trying to prevent fraud - no and im actually ecstatic that they are atleast trying to eliminate people who steal from the tax payer and are actually doing a good job at it.[/QUOTE

I can say I blame the government. They're the biggest thief to the taxpayer there is.

I don't see a thief here. I see a program that doesn't work. The doctor isn't getting paid enough to make it worth his/her efforts when you consider the time and resources medicare requires. So it makes sense that he/she wouldn't want those sorts of patients, particularly when the doctor patient relationship is eroded by bureaucratic red tape.

I tend to agree that we are liable to just go to a have and have not system where people who can afford private insurance will be able to get geriatric care.

Frankly, I don't agree with the cadillac health insurance plans mandated by the government. If I had to choose, I personally would rather have had some government help for catastrophic illnesses and leave the bulk of garden variety health care to private insurance. I am becoming pretty skeptical about all the pitches for diagnostic testing allegedly "catching things early" so you can cure them. And I haven't seen many people willing to make real lifestyle changes upon doctor's advice to ward off chronic illnesses, candidly. Other than paps and colonoscopies, a lot of that stuff seems like snake oil. I constantly get advertisements for various medical scans and whatnot and figure they wouldn't be out trying to scare up business if those procedures were everything they claimed they are.

It sounds like Obamacare is accelerating the segregation of Americans into health care "haves" and "have nots." The former have private insurance and are seen by better doctors at private practices, and the latter have Medicare and are seen by not-as-good doctors who are affiliated with hospitals.

I don't mean to disparage doctors in hospitals, but if I'm good and I can earn more money by striking out on my own, then I will. If I'm not as good, then I'll remain behind as a hospital staff physician and be paid less.

The problem is that specialists get paid a whole lot, while general practitioners, whether they work in a hospital or private practice get paid much, much less. We have a serious shortage of family practice and internal medicine docs out there precisely because they just get paid so much less than their peers, and still have the exact same med school loans. So grads often go into specialties, while only those who really, really want to do internal medicine get into it. Add the increasing medicare problems and malpractice insurance rates and you have a disaster waiting to happen.

Other than that, there's not some huge skill gap in doctors who work in private practices and those who work in hospitals. It's largely a preference thing and, in fact, many tend to work in both for a variety of reasons (when my dad was in private practice, he had to go see patients all the time in hospitals. You don't just pass off a patient to another doctor just because they can't get to your clinic). Private practice tends to have it's own associated costs that can make it hard to even break even unless you see an absurd volume in patients, which is one reason why doctors visits tend to be so short in private practice.

Frankly, I don't agree with the cadillac health insurance plans mandated by the government. If I had to choose, I personally would rather have had some government help for catastrophic illnesses and leave the bulk of garden variety health care to private insurance. I am becoming pretty skeptical about all the pitches for diagnostic testing allegedly "catching things early" so you can cure them. And I haven't seen many people willing to make real lifestyle changes upon doctor's advice to ward off chronic illnesses, candidly. Other than paps and colonoscopies, a lot of that stuff seems like snake oil. I constantly get advertisements for various medical scans and whatnot and figure they wouldn't be out trying to scare up business if those procedures were everything they claimed they are.

I don't know what ads you see in particular, but these diagnostic tools all tend to work just fine assuming the operator is skilled. I don't know why companies are starting to run them on demand like tanning booths, but these things being new doesn't mean they don't work. They all have their value.

The reimbursement thing pisses me off, but not because of what you probably think. The doctors bailing on it aren't getting paid back as much, so they are abandoning their patients. Boo freaking hoo doctors. So that meants you have to drive a lexus instead of a mercedes. Get over it. These same physicians are also still taking private insurers, so don't start feeling too bad for them. All the Blue Cross/Blue Shields/United/Cigna/etc commercial insurers out there are still paying them. What you will see, is that they will start adjusting down to match the medicare levels though. So the physicians will start to see the reimbursement on those decrease as well.

If you ever thought the system wasn't broken, just take an MRI bill for example. That'll run you $6K, and your part depends on your insurance. That same scan on the same machine in Canada, couple hundred bucks (what it's actually worth). Why all the high overhead? That's the millino dollar question in the U.S....litterally. If you ever watch your EOB and see how much is "discounted" by being a memeber of insurance, you'll see how crazy the mark-up is. In no way does it actually cost that much money to run an MRI...in no way, shape, or form. That goes merely to pockets of shareholders, flat out.

Our system rewards those physicians who request unrequired tests...the more you do, the more you charge, the more you make. So until we can come up with a new system that rewards QUALITY medicine rather than just quantity, without just passing the cost on to the patient, we're screwed. Why should i be forced to pay astronomical amounts if my doctor is unexperienced and asks for a million tests when a more experienced one might have it resolved in 10 minutes? The current system doesn't really encourage the two physicians to discuss the case either....and they would both charge for their services as well.

It's broken in every way possible.

We have a lot more MRI machines per capita than Canada, because patients don't want to have to wait 30 days or more to get one, which you might in Canada depending on where you live and how big the line is in front of you. If you need an MRI in the US, the amount of time you need to wait to get one on can typically be measured in hours, rather than weeks.

Health care is like anything else, it's customer driven. People who use the emergency room as doctor visits, people who want those tests and those very, very expensive machines and want it now, people who demand every physician be perfect and have no qualms litigating every issue even if the doctor did a good job, all those things get rolled into health care costs. A country like Canada rations things a lot more closely. You can't have it both ways, either you give the patient every possible tool and technique at their disposal, or you have low costs and patients have to wait, possibly living in excruciating pain for longer while waiting for their hip replacement. Doctor payments are a paper tiger in the debate.

The idea that a good doctor can look at you and come up with an accurate diagnosis is just false. Fact is, while there are unnecessary tests done, I'd be wary of any doctor who just decides in 10 minutes what's wrong with you. Our knowledge base involving diseases is expanding, we know more now than we knew 30 years ago and we have a lot better idea what we need to rule out. Unless it's a really, really obvious issue that no doctor should miss, it should take a little more time than that.

The infuriatingly self-perpetuating evil in all this is that the litigation drives doctors to unnecessary tests merely for the CYA principle. And I'm a perfect example - had a minor shoulder pain that I could not explain, wouldn't go away; went to my doctor, she ordered an ultrasound. Shoulder is fine. But she thinks there may be some kidney cysts on the ultrasound. Now, when I hear that, it's a little spooky - but then I did research, and found out that many if not most people my age have tiny, harmless, benign cysts in the kidneys, but the doc insisted I should have an MRI to check them out. Sure enough, that's exactly what I had, precisely in line with statistics, but the doctor's assistant tells me, "well, we have to be sure." And that was purely due to the CYA factor.

And the doc never did one other thing to further diagnose my shoulder issue.

The point is that doctors are spending no small amount of their time engaging in "preventive" lawsuit medicine rather than healing.

And I realize the other extreme is that we must have mechanisms to keep incompetent doctors from maiming people, and malpractice suits are one of those mechanisms, but reality sure needs to settle somewhere in the middle. The only ones profiting are the lawyers.

Medical care has the most complicated pay structure of anything we purchase. From my last doctor's visit:
- The examination and tests totaled $415.00 (100.00%).
- Insurance paid $173.93 (41.91%).
- "Adjustments/Discounts" were $167.90 (40.46%).
- My portion was $73.17 (17.63%).

I don't know what ads you see in particular, but these diagnostic tools all tend to work just fine assuming the operator is skilled. I don't know why companies are starting to run them on demand like tanning booths, but these things being new doesn't mean they don't work. They all have their value.
My point is the independent advertising. I have to think that if my physician thought I needed them, he'd send me in that direction. I don't doubt they do "some" good with certain people but just bringing in the hordes is what they appear to be doing. That's a cash cow.

Easy answer... Medicare/Obamacare. This is just the beginning too. We'll see more and more of stuff like this happening.

If you ever thought the system wasn't broken, just take an MRI bill for example. That'll run you $6K, and your part depends on your insurance. That same scan on the same machine in Canada, couple hundred bucks (what it's actually worth). Why all the high overhead? That's the millino dollar question in the U.S....litterally. If you ever watch your EOB and see how much is "discounted" by being a memeber of insurance, you'll see how crazy the mark-up is. In no way does it actually cost that much money to run an MRI...in no way, shape, or form. That goes merely to pockets of shareholders, flat out.

Our system rewards those physicians who request unrequired tests...the more you do, the more you charge, the more you make. So until we can come up with a new system that rewards QUALITY medicine rather than just quantity, without just passing the cost on to the patient, we're screwed. Why should i be forced to pay astronomical amounts if my doctor is unexperienced and asks for a million tests when a more experienced one might have it resolved in 10 minutes? The current system doesn't really encourage the two physicians to discuss the case either....and they would both charge for their services as well.

It's broken in every way possible.

Correct. What you are seeing is that if you have insurance, you are billed astronomical rates. The insurance pays and you are left feeling thrilled that you were wise enough to get insurance and happy that you didn't pass on such a huge burden to others. Regardless of what it actually ends up paying, the insurance makes money because so many people want to do the right thing and purchase it. It is a scam and Obamacare, which is an insurance plan, plays right into it.

If you don't have insurance or you have a high deductible, you don't get billed the insurance rate. They bill you pretty much what they do in Canada, i.e., what the stuff is actually worth. I have a high deductible insurance plan and haven't paid more than 20% of any "standard" rate in years. In fact, I can't recall paying more than $95.00 for anything, including emergency care, EKG's etc. Total. Usually, it is about twenty to fifty bucks, including for specialists.

We have a lot more MRI machines per capita than Canada, because patients don't want to have to wait 30 days or more to get one, which you might in Canada depending on where you live and how big the line is in front of you. If you need an MRI in the US, the amount of time you need to wait to get one on can typically be measured in hours, rather than weeks.

.

I've spent months in Canada for work and worked with Canadians at past jobs for years that were working as contractors here in the US.

You are completely wrong and you are allowing propaganda to influence your thought process.

There are billions of dollars to be made with misinformation and fear, and this is one of the areas that it is prevalent in. People allow themselves to forget that we are #1 in cost and #34 in the world in patient outcomes.

The CYA has been in place for years and something else that increased the number of testing ordered was doctor-owned hospitals. They are/were routinely referring patients to the hospital X-Ray room, or whatever, while owning a part of the hospital. Obamacare outlaws such chicanery as doctors must divest themselves of hospital ownership by a certain date.

I agree about Canada as well. The people living in Canada seem to like it very much and every system has its horror stories. It would take some real whoppers to beat the stories that come out of our own rotten for-profit system. It will take removing the insurance companies out of the system completely to ever really fix our health care system.

We have a lot more MRI machines per capita than Canada, because patients don't want to have to wait 30 days or more to get one, which you might in Canada depending on where you live and how big the line is in front of you. If you need an MRI in the US, the amount of time you need to wait to get one on can typically be measured in hours, rather than weeks.

Health care is like anything else, it's customer driven. People who use the emergency room as doctor visits, people who want those tests and those very, very expensive machines and want it now, people who demand every physician be perfect and have no qualms litigating every issue even if the doctor did a good job, all those things get rolled into health care costs. A country like Canada rations things a lot more closely. You can't have it both ways, either you give the patient every possible tool and technique at their disposal, or you have low costs and patients have to wait, possibly living in excruciating pain for longer while waiting for their hip replacement. Doctor payments are a paper tiger in the debate.

The idea that a good doctor can look at you and come up with an accurate diagnosis is just false. Fact is, while there are unnecessary tests done, I'd be wary of any doctor who just decides in 10 minutes what's wrong with you. Our knowledge base involving diseases is expanding, we know more now than we knew 30 years ago and we have a lot better idea what we need to rule out. Unless it's a really, really obvious issue that no doctor should miss, it should take a little more time than that.

Now compare how many wage hours it takes for the average Canadian to obtain the test, versus how many for the US worker. Doesn't matter if there is a 30 day or 1 day wait if the service is priced out of reach.

. . . all I know is that is is getting increasingly more difficult to find a Dr that will take a "combo" with Medicare. I have federal BCBS. . .elected to take Medicare as primary when I turned 65 with BCBS as secondary. Decided to switch Dr (and her lab) after a HUGE snafu with some medical tests. Still trying to find an internist who will take me mention the word Medicare, and the answer is no. Also heard "thru the grape-vine" that (under federal BCBS) if you don't take Medicare when you turn 65, all BCBS will pay is what Medicare would have approved. . . but don't know that for a fact. I fear we are in for a royal "cf".

All the bull people spread about Canadian healthcare taking sooo long to do anything is just that....bull. There are plenty European countries out there that have a better healthcare system than ours as well. In case you didn't know, the U.S. ranks pretty freaking LOW in terms of QUALITY healthcare. All the litigation crap and the drive for more money has turned it into this mess.

Sometimes I wonder if a single payer system would be better. Level the field and dont give poeple the option for all this nonsense. It's not as though all these people would be out of the job...they'd just have to transfer from the private companies over to the public system. Guess what, more people to help fun those lagging pension plans too. Oh wait....we won't have crazy insurance crap anymore with that....hmmm. :)

Lived in Canada for a short time and have many employees in Canada. They wouldn't take the US health care system for anything.

unless they want special care or the best surgeons ..

The CYA has been in place for years and something else that increased the number of testing ordered was doctor-owned hospitals. They are/were routinely referring patients to the hospital X-Ray room, or whatever, while owning a part of the hospital. Obamacare outlaws such chicanery as doctors must divest themselves of hospital ownership by a certain date.

I agree about Canada as well. The people living in Canada seem to like it very much and every system has its horror stories. It would take some real whoppers to beat the stories that come out of our own rotten for-profit system. It will take removing the insurance companies out of the system completely to ever really fix our health care system.

So every system has horror stories, but our for-profit system is inherently "rotten" because of the same kinds of "whoppers?" Can't have it both ways.

The hyperbole coming from both sides of this is part of the reason we are exactly where we are. Canada isn't a panacea, the US isn't a panacea, but there's something to be said that, for several decades, the US was where people came from all over the world for medical procedures not available anywhere else. This idea that the US system is or always was this wretched mass of failure is as ludicrous as the claims of "death panels" under Obamacare, which as much as I loathed (and still loathe) Obamacare, I knew wasn't true.

Doctor-owned hospitals may have their drawbacks, but for many such organizations they were a way to consolidate resources, reduce bureaucracy, and pass savings on to patients. My son had two ENT procedures done on an outpatient basis at a doctor-owned surgical hospital for a fraction of what those procedures would have cost through a conventional surgical/hospital setup. That Obamacare makes them illegal speaks more to Obama's broader economic objectives than to his preoccupation with health care in particular.

My friend, my boss, an extremely wealthy man with a family, has never stepped foot in the US for healthcare.

so that clearly proves the point

Right. Not going to debate this silly thing. I've spent enough time there and have enough CA employees to have a reasonable understanding of the situation. They. Laugh. At. Our. Healthcare.

Debunking Canadian health care myths - The Denver Post (http://www.denverpost.com/recommended/ci_12523427)

when you say "our healthcare" whose do you mean??

I've spent months in Canada for work and worked with Canadians at past jobs for years that were working as contractors here in the US.

You are completely wrong and you are allowing propaganda to influence your thought process.

There are billions of dollars to be made with misinformation and fear, and this is one of the areas that it is prevalent in. People allow themselves to forget that we are #1 in cost and #34 in the world in patient outcomes.

Management of MRI Wait Lists in Canada (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653696/)

When measured by the median number of days to scan or by the total numbers of patients waiting for scans, wait list size varied substantially. The median number of patients on the wait list was 1,000 (IQR: 444–1992). Wait times for the most urgent priority studies varied from less than 24 hours to more than one month. The wait times for the most elective category varied from 28 days to three years, with one centre stating that they were simply unable to scan cases prioritized as elective.

The ability to meet target wait times varied markedly. Despite being able to choose their own target wait times, 12/74 (16%) of centres did not meet their target wait times for any priority category, even the most urgent scans. Forty-five per cent of centres responded that they met target times only for some prioritization categories. Only 39% of centres reported meeting their wait time targets for all categories.

All the evidence I have ever seen says that unless it's urgent, there's a wait list issue for people. Even people who debunk a lot of myths recognize that Canada has wait list issues. Not that they never get care, but that rather than pay more like we do, they pay less and wait more and non-urgent issues often have a fairly long wait. If you have any evidence to the contrary, I'm certainly open it it. But having worked in Canada doesn't make you an expert on the breadth of health care system any more than living in Oklahoma makes me an expert on soil management in the great plains. Unless your job actually required you to count the number of MRI's in Canada, it doesn't really disprove what I said.


Now compare how many wage hours it takes for the average Canadian to obtain the test, versus how many for the US worker. Doesn't matter if there is a 30 day or 1 day wait if the service is priced out of reach.

That's a fair opinion, and no one is saying cost isn't an issue. Both deserve honest discussion, but the is a whole lot more complex issue than just yelling "Canadians don't have to pay, they're better off!" as though there are absolutely no cons for patients in that system. It's also not nearly as simple as saying "Look at X country" when x country has a quarter of the population and 1/15th the area to cover, because that's just ignoring the basic population issues that come with care.

Cost is an issue in the US, we sort of traded it for convenience to the point where we've priced a lot of citizens out of care. That's something we have to address.


Lived in Canada for a short time and have many employees in Canada. They wouldn't take the US health care system for anything.

I have friends in the UK who absolutely hate their health care system, because while they don't pay, they're miserable as they go through the process because it takes them a long time to get permission for care they need. They've actually spoken positively about our health care system simply because there are times they'd rather pay than wait to go see their doctor for pain, then wait longer to go see the specialist for pain, simply because it wasn't deemed urgent.

The point? Being someplace can only tell you about their perception of the system.


My friend, my boss, an extremely wealthy man with a family, has never stepped foot in the US for healthcare.

I hope they never have to. But them not doing so does not mean it never happens. A few years ago, a Canadian official decided that he'd rather use US surgeons in a US hospital rather than Canada's for a procedure (http://www.cbc.ca/news/canada/newfoundland-labrador/story/2010/02/01/nl-williams-heart-201.html). And it's not unheard of (http://www.freep.com/article/20090820/BUSINESS06/908200420/Canadians-visit-U-S-get-health-care) for Canadians with non-urgent care to travel across the border.

My point is the independent advertising. I have to think that if my physician thought I needed them, he'd send me in that direction. I don't doubt they do "some" good with certain people but just bringing in the hordes is what they appear to be doing. That's a cash cow.

I consider it catering to hypochondriacs. Some people sleep better at night if they can get consistent screenings. You're right in that if your physician thinks you need a test, he'll order it. Some people just don't trust their physicians though, especially when they have the internet telling them how sick they could be.

I consider it catering to hypochondriacs. Some people sleep better at night if they can get consistent screenings. You're right in that if your physician thinks you need a test, he'll order it. Some people just don't trust their physicians though, especially when they have the internet telling them how sick they could be.

Sometimes I remember, fondly, when hypochondriacs were primarily characters in theater or comedies trotted out for comic effect. These days, I think about 80% of us have turned into hypochondriacs (I sometimes edge into that category). I am sure the internet is part of it but another part is that there are just so many people willing to take your money while you track down what is killing you (even if nothing is killing you). We are no longer something ridiculous - hypochondria has gone mainstream. A doctor friend of mine gets exasperated at people walking into the ER who are convinced they are dying but there really isn't anything seriously wrong with them.

As a society, I think we are having a psychotic episode.

As the saying goes, a little bit of information is a dangerous thing. I think as information regarding health became more easily spread, people began to worry obsessively over it. Consistent stories about studies into what will or won't cause cancer, stories spreading about someone with minor back pain ending up with an inoperable brain tumor, celebrities becoming medical experts about rare diseases, and so forth. Thing is, we genuinely have gotten way better at diagnosing and identifying disease, and knowing what causes diseases, and those things get muddied because of media scares. Add something like WebMD, which makes it incredible easy to be a hypochondriac, and you get a society that obsesses over health like never before.

I think that initially caused your issue, less-than-scrupulous people to try to profit off panicky people, making outlandish and unsupported claims that drive people into their clinics. Add that to pseudo-scientific shysters , who are even more willing to buy ads and tell you that they can cure diabetes by straightening your spine or sprinkle powder onto your food to make you lose weight and the initial problem just gets worse and worse. And if someone's health actually improves after doing something, even if it would have improved naturally, it just gives an unwarranted achievement to people who lucked out by placebo.

We're in a nasty spiral regarding public attitudes to health, and once people get on a particular health train, getting them off of it tends to be incredibly difficult.

The reimbursement thing pisses me off, but not because of what you probably think. The doctors bailing on it aren't getting paid back as much, so they are abandoning their patients. Boo freaking hoo doctors. So that meants you have to drive a lexus instead of a mercedes. Get over it. These same physicians are also still taking private insurers, so don't start feeling too bad for them. All the Blue Cross/Blue Shields/United/Cigna/etc commercial insurers out there are still paying them. What you will see, is that they will start adjusting down to match the medicare levels though. So the physicians will start to see the reimbursement on those decrease as well.

If you ever thought the system wasn't broken, just take an MRI bill for example. That'll run you $6K, and your part depends on your insurance. That same scan on the same machine in Canada, couple hundred bucks (what it's actually worth). Why all the high overhead? That's the millino dollar question in the U.S....litterally. If you ever watch your EOB and see how much is "discounted" by being a memeber of insurance, you'll see how crazy the mark-up is. In no way does it actually cost that much money to run an MRI...in no way, shape, or form. That goes merely to pockets of shareholders, flat out.

Our system rewards those physicians who request unrequired tests...the more you do, the more you charge, the more you make. So until we can come up with a new system that rewards QUALITY medicine rather than just quantity, without just passing the cost on to the patient, we're screwed. Why should i be forced to pay astronomical amounts if my doctor is unexperienced and asks for a million tests when a more experienced one might have it resolved in 10 minutes? The current system doesn't really encourage the two physicians to discuss the case either....and they would both charge for their services as well.
It's broken in every way possible.

First of all, very few physicians receive any compensation for ordering more tests. I don't have part ownership of an MRI machine, nor does anyone else I know. Physicians order too many tests because they are afraid of making a mistake - afraid of getting sued, and for good reason. We all seem to expect people who become ill to be cured and return to the same level of health they had prior to their illness. People expect that no stone should be left unturned to treat their family member, regardless of their ability to pay and potential ability to recover from their illness. We spent massive amounts of money keeping people with terminal diseases alive as long as humanly possible, frequently tormenting them through the process. When the hospitalization is over, they think health care should be free and are happy tucking bills in drawers and never making an attempt to pay. Doctors, who have spent a minimum of 7 years doing postgraduate work, frequently work 100 weeks to make those "great salaries". If you calculate what they're reimbursed for 40 hours, it's frequently not very impressive. My husband ran his office practice at a loss for years, as the government froze reimbursement while allowing rent, taxes, wages and employee benefits to rise. At some point, worki g as a paid employee of the hospital began to sound great. And we get what we're willing to pay for. He might be around to see you in the office if you're sick,or maybe not. He won't meet you in the ER if you go there and he may or may not follow you in the hospital. Cost savings lead to impersonality. But we can't have it all. Something has to be rationed, and hard choices need to be made.

Thanks, Betts. Appreciate the comment from the trenches.

. We spent massive amounts of money keeping people with terminal diseases alive as long as humanly possible, frequently tormenting them through the process. When the hospitalization is over, they think health care should be free and are happy tucking bills in drawers and never making an attempt to pay.

I agree. After watching loved ones who endured years of poor health, numerous trips in/out of the hospital for terminal conditions, dealing with hospice and watching them suffer for years. I would be lying if I didnt say some part of me wishes it was more like the 'olden days'.

I'm glad those family members lived for the period of time that they did, but after a certain point where people are pumped full of so many drugs and still in so much pain where they cant move or do anything by themselves. What truely is the quality of life at that point.

When medical care is "free," a lot of us would try anthing to live another three months. If it was going to bankrupt your surviving spouse or use up your children's inheritance, I suspect many among us would make different decisions regarding end of life medical care.

When medical care is "free," a lot of us would try anthing to live another three months. If it was going to bankrupt your surviving spouse or use up your children's inheritance, I suspect many among us would make different decisions regarding end of life medical care.

Possibly, PQ, but as someone who's mother just passed away a few months ago, that was never a consideration in our family.

Possibly, PQ, but as someone who's mother just passed away a few months ago, that was never a consideration in our family.

I've lost parents and grandparents that I was very close with and I understand the pain. But the idea that you would devote the her entire estate and personally go into massive amounts of debt to keep a terminal person alive just a little longer is completely insane.

Before you take offense, the death that ive dealt with in 2 out of 3 elders was cancer related and the other one old age(and she was very clear that she was ready to go).

I think if something sudden happened like a car accident to an elder who was in good health, then you can let your emotions run high. But with people who have had (in my experience) years of chemo, surgery, experimental procedures, etc,etc,etc..and doctors keeping them alive by pumping them full of pain meds at some point you have to step back and who are we really doing this for--us or them?

When it's my time then it's my time, I have a living will that says don't drag out my life.

Betts, that's simply not true. The MRI was an example, but it by no means covers all of health care. Directly and indirectly, a physicians gets compensated for more tests. While the actual test may not go in to their pocket, the extra appointment and time for reviewing it does. Not to mention if there is a relationship between the office and the place the test is done (and we're not just talking MRI's here).

I do know this is true because of all of the years i've worked in medical billing.

William Tell - That's something that keeps coming up. It's a decision that must be made by everyone....but best left in the hands of the patient BEFORE it comes to that. That's what the living will is for. Spell out what you want to have happen before you need it so there is no question. My grandmother-in-law passed away last year after a battle with cancer. In her last hospital stay, she knew it was terminal and simply told everyone to stop. After a few weeks, she was able to die peacefully with her family at her side. That doesn't mean that it wasn't as difficult for us as it would be for someone that fought the whole way knowing it was of no good. There are countless books, articles, etc written on the outrageous amounts of money spent on the last few weeks/months of a person's life. Any geriatrist can tell you about that work...bless them for doing that work. That whole "death board" thing triggers a lot of emotions in people. But you simply don't have to have that discussion if you decide (in writing) before you get to that point. My wife and i do not want to be vegetables. So should it come to that, we have been clear what our wishes are. It's still horrible to think about, but you need to do what the patient wants to have happen, not you as the family member.

Bomber, insurance reimbursed office visits barely pay for themselves. That's why doctors are leaving private practice in droves or going to a cash only basis. The only reimbursed office visits that pay for themselves are the five minute ones where you tell the doctor you have a sore throat and he/she hands you a prescription. That's one of the reasons we have such a problem with resistant bacteria. Handing someone a prescription makes them happy and allows you to move on to the next patient. Taking the time to test and see if you have strep throat and, if you don't, counseling you on the fact that you have a virus, what to expect and reasons to return costs the doctor money. Insurance companies reimburse very poorly for office visits, especially if you're a primary care doctor. The same holds for giving people test results. It takes far more time and you are poorly reimbursed for time. Medicare has basically been frozen for years, while office overhead costs have not. It is true that tests make money for someone, but it's rarely the doctor. So, if a hospital can get together a fleet of doctors dedicated to it, the hospital has a group that feeds it the tests it uses to stay profitable and it pays the doctor a decent salary. Or, if you're a surgeon or have an invasive procedure you can charge geometrically more for your time. That's why lately the top students have been going into orthopedics and ophthalmology or a surgical sub specialty. Those are the doctors insurance companies are willing to reimburse. We like to joke that doctors get far more for using their hands than their brain, but its basically the truth.

Bomber, insurance reimbursed office visits barely pay for themselves. .

Doctors hate the system because of cost
Patients hate the system because of cost

Who doesnt hate it..insurance companies. Everyone in the equation loses money besides them. Number 1 in the world in cost, 34th in patient outcomes.

I like the cash idea.

I've lost parents and grandparents that I was very close with and I understand the pain. But the idea that you would devote the her entire estate and personally go into massive amounts of debt to keep a terminal person alive just a little longer is completely insane.

Before you take offense, the death that ive dealt with in 2 out of 3 elders was cancer related and the other one old age(and she was very clear that she was ready to go).

I think if something sudden happened like a car accident to an elder who was in good health, then you can let your emotions run high. But with people who have had (in my experience) years of chemo, surgery, experimental procedures, etc,etc,etc..and doctors keeping them alive by pumping them full of pain meds at some point you have to step back and who are we really doing this for--us or them?

I'm not offended but the scenario you describe was not valid in my case. My point was that our family just never discussed finances when making medical decisions for my mother. I was her medical power of attorney and did everything possible for her based on her prior wishes.

Two links with exerpts, both written by physicians and published in the Wall Street Journal this week. The first is from Dr. Jeffrey Singer writing in the May issue of Reason Magazine:
Notable & Quotable - WSJ.com (http://online.wsj.com/article/SB10001424127887323296504578396790015964744.html?m od=WSJ_Opinion_LEFTTopOpinion)
"In the not-too-distant future, a small but healthy market will arise for cash-only, personalized, private care. For those who can afford it, there will always be competitive, market-driven clinics, hospitals, surgicenters, and other arrangements—including "medical tourism," whereby health care packages are offered at competitive rates in overseas medical centers. Similar healthy markets already exist in areas such as Lasik eye surgery and cosmetic procedures. The medical profession will survive and even thrive in these small private niches.

In other words, we're about to experience the two-tiered system that already exists in most parts of the world that provide "universal coverage." Those who have the financial means will still be able to get prompt, courteous, personalized, state-of-the-art health care from providers who consider themselves professionals. But the majority can expect long lines, mediocre and impersonal care from shift-working providers, subtle but definite rationing, and slowly deteriorating outcomes.

We already see this in Canada, where cash-only clinics are beginning to spring up, and the United Kingdom, where a small but healthy private system exists side-by-side with the National Health Service, providing high-end, fee-for-service, private health care, with little or no waiting."

And this from a former pediatrician who gave up his license and now raises Christmas trees:
Ed Marsh: Reflections of a Medical Ex-Practitioner - WSJ.com (http://online.wsj.com/article/SB10001424127887324789504578380382204116270.html?m od=WSJ_Opinion_LEADTop)
"When it became increasingly difficult to work according to my principles, I closed my practice, first joining a "prepaid" group for 15 years, and then leaving patient care altogether. As more physicians leave active practice, it must be appreciated that a focus on the economics of health care is not the only, and perhaps not even the most important, reason for their disillusionment. The glow of the personal relationship one might have with one's patients is being extinguished."

A fairly wise doctor I know said something I repeat from time to time. "Everyone pays for health care. If you have money, you pay with money. If you don't have money you pay with time." At first listen, it sounds elitist. But, the more I thought about it, the more it made sense. People who work exchange their time for money. If you don't or can't work, you simply skip one step in the process. So, as long as the doctors in the second tier care about their patients, I don't think anyone is losing out. And I really don't think compensation is at all related to compassion and care. I suspect it's randomly distributed between both tiers.