Questions you want answered (P&C Edition)

In a recent story about the ACA in Florida was this little tidbit.

Florida's governor, Rick Scott, is a former hospital executive who got into politics to fight the health care overhaul. While Obamacare was still in the courts, Scott said he didn't yet consider it the "law of the land." Even after it was upheld by the Supreme Court, the governor refused to implement the law, waiting for the election.

A lot about this story had me thinking but the part I'm latching onto here is that Rick Scott was a former hospital executive who is against the health care overhaul. My wife is a nurse and I would say the large majority of the doctors and nurses she works with are also against the ACA, of course they all practice in Alabama so there is the natural conservative slant, but... My question is, why does it seem that so many people in healthcare are against healthcare reform?

I've talked about this with my wife and she tends to chalk it up to the doctors and nurses just not understanding what the law actually does while a few of the higher ups just being worried about insurance companies cutting what they pay hospitals. The primary complaints she hears are doctors fearing that their pay is going to be slashed to "European levels" while the nurses tend to either fear they're going to get fired, though they can't explain why, or that they're going to be even more overworked because more people are going to be seeking care but the hospitals arent going to hire any new staff. A few others are just convinced they're somehow going to end up paying higher taxes because of the law.

To me it seems like people in the healthcare field should be excited over the reform because, in theory, they're going to have fewer uninsured people skipping out on bills and a higher demand for their services as more insured people would tend to mean more people seeking preventative, as opposed to emergency care. Anyone else have any insights into this? I just find it odd that so many in healthcare seem to be opposed to this.

Because implementing a huge new system means more work? If you already work for a thankless employer I can see how that would be really unappealing.

My wife is a pharmacist in a hospital in CT, and she's also dead against the ACA. Of course, she's also a staunch Republican, so that probably has a lot to do with it. That said, according to her a lot of her colleagues (doctors, nurses and pharmacists) are in full agreement with her. They seem to feel that it will result in the hospital losing money to freeloaders, though at the same time they are not happy with the 'emergency room care for everyone regardless of ability to pay' thing either, which as I understand it ACA will do away with.

they are not happy with the 'emergency room care for everyone regardless of ability to pay' thing

Ummm... so the Hippocratic Oath... never mind.

result in the hospital losing money to freeloaders

As opposed to... what's happening right now?

Rallick wrote:

My wife is a pharmacist in a hospital in CT, and she's also dead against the ACA. Of course, she's also a staunch Republican, so that probably has a lot to do with it. That said, according to her a lot of her colleagues (doctors, nurses and pharmacists) are in full agreement with her. They seem to feel that it will result in the hospital losing money to freeloaders, though at the same time they are not happy with the 'emergency room care for everyone regardless of ability to pay' thing either, which as I understand it ACA will do away with.

In a shocking turn of events, it turns out doctors, nurses, and other health professionals are just as clueless as most Americans.

I don't know how anyone who even pays the smallest amount of attention can assume that THAT is going to be the result. Especially conservatives - they were the ones freaking out about people being forced to have insurance, right?!

billt721 wrote:
Rallick wrote:

My wife is a pharmacist in a hospital in CT, and she's also dead against the ACA. Of course, she's also a staunch Republican, so that probably has a lot to do with it. That said, according to her a lot of her colleagues (doctors, nurses and pharmacists) are in full agreement with her. They seem to feel that it will result in the hospital losing money to freeloaders, though at the same time they are not happy with the 'emergency room care for everyone regardless of ability to pay' thing either, which as I understand it ACA will do away with.

In a shocking turn of events, it turns out doctors, nurses, and other health professionals are just as clueless as most Americans.

I don't know how anyone who even pays the smallest amount of attention can assume that THAT is going to be the result. Especially conservatives - they were the ones freaking out about people being forced to have insurance, right?!

My favorite is that this really would not differ from what is already happening to hospitals. A lot of people use hospitals because they cannot pay for preventative care or the emergency care they receive as a result of not having preventative care. Can you really blame a pre-existing condition on the new medication? Guess insurance companies that now have to cover pre-existing coniditions can forge that brave new world.

Kehama wrote:

A lot about this story had me thinking but the part I'm latching onto here is that Rick Scott was a former hospital executive who is against the health care overhaul.

He wasn't just a former hospital executive. He was the CEO of a company that committed widespread Medicare and Medicaid fraud by billing the government for tests they didn't do and "upcoding" patient diagnoses in order to get higher reimbursements.

Remember how $700+ billion of ACA funding is going to come from reducing payments to Medicare providers and savings generated from cracking down on fraud? That's saying to folks like Scott that their ride on the gravy train is ending. Of course they're going to be against it.

I assume much of medical industry being against the ACA is how oil and coal executives are against moving subsidies from oil and coal onto wind, solar, and renewable. By and large those in the FUBAR system, benefit greatly at the expense of the whole. The same trace is had when you see the impact of the Great Depression upon the super rich, not much.

Rallick wrote:

My wife is a pharmacist in a hospital in CT, and she's also dead against the ACA. Of course, she's also a staunch Republican, so that probably has a lot to do with it. That said, according to her a lot of her colleagues (doctors, nurses and pharmacists) are in full agreement with her. They seem to feel that it will result in the hospital losing money to freeloaders, though at the same time they are not happy with the 'emergency room care for everyone regardless of ability to pay' thing either, which as I understand it ACA will do away with.

It just comes down to political ideology. My wife recently left a hospital in Omaha where most of her colleagues were more conservative and aggressively anti-ACA, whereas the hospital she currently works at is generally more liberal and pro-ACA.

My dad's a physician and fully supports Obama and ACA. He told me that of all insurance providers, Medicare negotiates the hardest and pays out the least by far compared to private insurers. Because it's government program, Medicare is actually extremely diligent in making sure doctors only get paid for what they bill for, more so than the private insurers. This is good on one level (government more fiscally responsible than private businesses? Crazy!), but the problem is that the coding system used to determine how much the doctor gets reimbursed is often unclear, and Medicare will reduce reimbursements for even the tiniest discrepancy in the description of services rendered. This means even a typo in the treatment description can cost the doctor money. It also means the doctor has to write descriptions for every single action he or she took involving the patient, even if there is no change in the patient's condition or treatment given, which ends up taking up a huge amount of the doctor's time when you have even just a few patients to see. That is time, I think, that could be better spent by seeing more patients or spending more time with the patients.

The other challenge he is concerned about is the increase in patient visits after ACA is fully implemented, as with declining interest in primary care we may be about 50,000 short on primary care physicians nationwide. This, plus the rise in elderly and obese patients he is seeing (for the first time in his 40+ years he has seen patients that won't fit in the CT scanner), may mean we see a significant shortage of doctors in the coming decade.

So ACA will have to find a way to deal with these issues without letting costs rise too fast. What I would hope happens is another wave of foreign doctors entering the US who are cheaper to employ. That's how he came over

I wonder why I heard noise about a doctor bubble then? Is that just hyperbole?

clover wrote:

I wonder why I heard noise about a doctor bubble then? Is that just hyperbole?

I think that there is a bubble in terms of specialists but not primary care physicians.

Chairman_Mao wrote:

This is good on one level (government more fiscally responsible than private businesses? Crazy!), but the problem is that the coding system used to determine how much the doctor gets reimbursed is often unclear, and Medicare will reduce reimbursements for even the tiniest discrepancy in the description of services rendered. This means even a typo in the treatment description can cost the doctor money. It also means the doctor has to write descriptions for every single action he or she took involving the patient, even if there is no change in the patient's condition or treatment given, which ends up taking up a huge amount of the doctor's time when you have even just a few patients to see. That is time, I think, that could be better spent by seeing more patients or spending more time with the patients.

Doesn't the ACA include a massive expansion in the number of reimbursement codes, meaning that doctor's will be able to be very specific about the the problem and treatment (and therefore confident in how much they're going to get paid)? I understand that that means a lot more administrative work, but I don't see a way around that until the government simply pays doctors a straight salary.

As long as doctors bill by procedure, the taxpayer in me wants them to have to document everything.

OG_slinger wrote:
Chairman_Mao wrote:

This is good on one level (government more fiscally responsible than private businesses? Crazy!), but the problem is that the coding system used to determine how much the doctor gets reimbursed is often unclear, and Medicare will reduce reimbursements for even the tiniest discrepancy in the description of services rendered. This means even a typo in the treatment description can cost the doctor money. It also means the doctor has to write descriptions for every single action he or she took involving the patient, even if there is no change in the patient's condition or treatment given, which ends up taking up a huge amount of the doctor's time when you have even just a few patients to see. That is time, I think, that could be better spent by seeing more patients or spending more time with the patients.

Doesn't the ACA include a massive expansion in the number of reimbursement codes, meaning that doctor's will be able to be very specific about the the problem and treatment (and therefore confident in how much they're going to get paid)? I understand that that means a lot more administrative work, but I don't see a way around that until the government simply pays doctors a straight salary.

As long as doctors bill by procedure, the taxpayer in me wants them to have to document everything.

edit: regarding ACA codes, I don't know what's changing there. But adding codes doesn't seem to be a problem solver, unless Medicare stops looking at the descriptions doctors are required to provide. Apparently they take the time to do that, much more so than private insurers do.

I agree with you since it's taxpayer funded. I'm not sure there's a better way to do it, rather it just seems to be an inevitable inefficiency inherent to a publicly funded system. In this one aspect I see private insurance companies able to be more flexible than Medicare, potentially saving doctors time and paying them more. But I don't think that that advantage offsets the value Medicare provides to patients. Dad makes enough money, he's not all up in arms about it. He also didn't pay $200k to go to medical school though, so I could see it being a bit more of a thorn in the side of younger doctors who were educated in the US.

I know of several MDs of my acquaintance who are US citizens who came to the Philippines to train and go to medical school, with the intention of practicing in the US. Back in the day, the cost was something like $3000 per annum or thereabouts. I think it's up to $8000 now with board and lodging, so it amounts to $40k for 5 years. As far as I know, passing rate on the MLE among those I personally know is 100%. It's the matching that screws them over.

Still, starting off without student debt is fantastic, from what I've heard as long as you're never in any danger of being permanently deported if you get unemployed for a week.

Chairman_Mao wrote:

regarding ACA codes, I don't know what's changing there. But adding codes doesn't seem to be a problem solver, unless Medicare stops looking at the descriptions doctors are required to provide. Apparently they take the time to do that, much more so than private insurers do.

I can't speak for the other paperwork requirements, but my understanding is that the changes in the codes are to make better distinctions between different problems. The current system might have one code for "set broken arm" (not specifying what part broke, or even which arm), whereas the new one might have a code for "set break in left ulna". That ought to mean less situations where charges can get sent back because somebody (or some computer) decided that it was a duplicate charge. I would hope that it also means less need for detailed explanations of the work done, but that's harder to say. Certainly it ought to mean you can leave out the details that *are* covered by the code, and focus on things that are more significant.

LarryC wrote:

I know of several MDs of my acquaintance who are US citizens who came to the Philippines to train and go to medical school, with the intention of practicing in the US. Back in the day, the cost was something like $3000 per annum or thereabouts. I think it's up to $8000 now with board and lodging, so it amounts to $40k for 5 years. As far as I know, passing rate on the MLE among those I personally know is 100%. It's the matching that screws them over.

Still, starting off without student debt is fantastic, from what I've heard as long as you're never in any danger of being permanently deported if you get unemployed for a week.

Don't think doctor unemployment is a big issue in the US. Hospital based private practices, however, have declined because hospitals now hire "hospitalists", doctors who only see inpatients. So, at least where my dad is based, this trend has pushed private practice physicians either into early retirement or outpatient-only practices that are in an office at another location. My dad and one other doctor are the only private practice physicians who still see their own inpatients at that hospital.

Here's a description of the new procedure code set. Basically, the idea is that with the codes being far more specific (including distinguishing between left and right sides), the doctor writes less to convey what was done with the patient. The prerequisite for these codes came into use Jan 1, 2012 via the ACA, so your doctor should already be using them.

I've seen several articles lately trying very, very hard to make a big deal out of Django Unchained's use of "The N Word" as they like to say. I'm still amazed at what can get people's hackles up. Scenes of rape, murder, torture... no problem. Use a word that reminds us how horribly overtly racist the US used to be? Whoa! Back off!

Is Tarantino using intentionally offensive language to shock the audience? Well, yeah, that's what he does. It's what he's always done. Is it also period appropriate for a revenge flick about a slave? Also, yeah.

I'm just wondering how genuine this outrage is. Often, it seems to me, that people want to scream about things like this not because they're genuinely offended but because they feel like they have to be offended in order to show how progressive and tolerant they are and as a kind of apology for the behavior of previous generations.

JC wrote:

This law firm should be disbarred immediately. Why is this garbage allowed?

http://usnews.nbcnews.com/_news/2012/12/29/16233914-lawyer-for-newtown-shooting-survivor-seeks-to-file-100-million-lawsuit?lite

Isn't school board money basically tax money, in effect they're suing themselves?

"foreseeable harm." err what? I hope the judge, if it makes it that far, throws this out so as not to set a precedent for people exploiting these situations.

JC wrote:

This law firm should be disbarred immediately. Why is this garbage allowed?

http://usnews.nbcnews.com/_news/2012/12/29/16233914-lawyer-for-newtown-shooting-survivor-seeks-to-file-100-million-lawsuit?lite

Likely because the NRA got Congress to change the law so that gun dealers and gun manufacturers are immune from being sued for the horrible things their products do. Since it's simply not possible to sue Bushmaster Firearms, the lawyers likely went after the next biggest set of pockets: the school system.

And here i was thinking parents would just be happy their kids were alive... sigh.

Demosthenes wrote:

And here i was thinking parents would just be happy their kids were alive... sigh.

Good therapy isn't cheap.

Lawyer's name is Irv Pinsky. He's certainly doing a great job of looking like a greedy ambulance chaser

IMAGE(http://www.addictinginfo.org/wp-content/uploads/2012/12/Atty.-Irv-Pinsky-at-his-office.jpg)

clover wrote:
Demosthenes wrote:

And here i was thinking parents would just be happy their kids were alive... sigh.

Good therapy isn't cheap.

I get that... but how are you going to sue the random location that was chosen by the gunman. A location, furthermore, who lost several good people and employees of that location who died trying to make sure that child and others came home alive. Not even getting into the whole suing themselves, this just screams of trying to cash in in an absolutely ridiculous and repugnant way.

Pinsky's claim said that the state Board of Education, Department of Education and Education Commissioner had failed to take appropriate steps to protect children from "foreseeable harm."
It said they had failed to provide a "safe school setting" or design "an effective student safety emergency response plan and protocol."
Pinsky said he was approached by the child's parents within a week of the shooting.

Emphasis Mine.

Is a mass school shooting unforeseeable?

KingGorilla wrote:
Pinsky's claim said that the state Board of Education, Department of Education and Education Commissioner had failed to take appropriate steps to protect children from "foreseeable harm."
It said they had failed to provide a "safe school setting" or design "an effective student safety emergency response plan and protocol."
Pinsky said he was approached by the child's parents within a week of the shooting.

Emphasis Mine.

Is a mass school shooting unforeseeable?

I seem to remember there being mention that the school required photo ID to get in. I would say there are unforeaeeable at any particular location until they occur... though a few weeks ago it would not have been expected that this could occur at an elementary school.

JC wrote:

Lawyer's name is Irv Pinsky. He's certainly doing a great job of looking like a greedy ambulance chaser

IMAGE(http://www.addictinginfo.org/wp-content/uploads/2012/12/Atty.-Irv-Pinsky-at-his-office.jpg)

Out of curiousity, why is there an image of motorcycles on that van?

Rallick wrote:

My wife is a pharmacist in a hospital in CT, and she's also dead against the ACA.

For what it's worth, I work for IT on Wall St, and a lot of my co-workers are dead set against any possible financial services reform.