Facility Fees are Ruining Quality Care

[drusso]

This sums up the problem in Pain Medicine

Facility fees are ruining quality care

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[hyperalgesia]

This sums up the problem in Pain Medicine

Facility fees are ruining quality care

Completely agree this is a HUGE problem. The government should be looking out for schemes that corrupt the marketplace. Instead, it is promoting schemes that corrupt the marketplace. Add to that states' "Certificate of Need" to protect the crooked schemes and we've got a great banana republic-style system. Bottom's up hospital owners!

 

[drpainfree]

yup...elimination of facility charge is what can save healthcare cost in this country, immediately.

 

[Disciple]

Facing a financial squeeze, hospitals nationwide are cutting jobs

Depending on how this round of healthcare reform goes, if hospitals lose the facility fees, or even if they get cut, they could be in trouble.

 

[DrCommonSense]

This sums up the problem in Pain Medicine

Facility fees are ruining quality care

Actually facility fees are a SYMPTOM of the problem. The high fees are needed to keep paying the large administrative burden in healthcare.

30% of Medical Bills Go To Administrative Costs - SingleCare Blog

Bloated facility fees are needed to pay for the large administrative staff, excessive costs of devices/goods, etc.

That is why large hospital lobbying groups pushing for HIGHER fees for hospital settings for the same procedures.

 

[DrCommonSense]

Facing a financial squeeze, hospitals nationwide are cutting jobs

Depending on how this round of healthcare reform goes, if hospitals lose the facility fees, or even if they get cut, they could be in trouble.

How much is the CEO making in each of these hospitals that are in "trouble"? How many administrators do these hospitals have?

Its amazing how the number of total administrators have gone up EXPONENTIALLY with huge increases in salaries despite this "crisis".

How do you explain the below graph if there is such a "crisis"?

 

[Ducttape]

It's easy to blame the problem on facility fees.

The problem however is not the fees itself, imo - I will argue it is the "distribution" of such fees.

These clinics are usually closing because they can't afford to stay open. Read the second paragraph. Eliminating facility fees will do nothing to help clinics that are not generating enough income because Medicaid pays so poorly. But if you eliminate facility fees, hospitals will no longer buy struggling clinics - the clinics will just disappear...

I say increase payments to office based clinics so they can remain fiscally viable. Let offices charge an office fee independent of physician/ global fee (fund it by reducing facility fees to hospitals and ASCs). Level the playing field by making the PP more profitable.

Other than that, eliminate 2/3 of all admin and make them more accountable would go a long way...


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[SSdoc33]

again, hospitals see the indigent. no matter how preachy the private practice docs may appear, they will not (nor should they) see the medicaid or free care patient which loses them money. the only way the SOS differential should be eliminated is if there is a concomitant increase in medicaid reimbursements. you see that happening with the current trumpcare agenda?

 

[nvrsumr]

again, hospitals see the indigent. no matter how preachy the private practice docs may appear, they will not (nor should they) see the medicaid or free care patient which loses them money. the only way the SOS differential should be eliminated is if there is a concomitant increase in medicaid reimbursements. you see that happening with the current trumpcare agenda?

There are two games in town for PP- increase volume and efficiency with lower margin payors (caid) or fight for the ever smaller pie of "good" insurance patients and then go OON ASC and anesthesia services. The Obamacare exchange patients don't count as they have too high of a deductible to actually get care until December each year.

Most PP are opting for option one. Hospitals are inefficient for chronic care. In Britain the NHS is attempting to change from a centralized hospital based system to one based on clinics to improve efficiency and cost.

 

[hyperalgesia]

again, hospitals see the indigent. no matter how preachy the private practice docs may appear, they will not (nor should they) see the medicaid or free care patient which loses them money. the only way the SOS differential should be eliminated is if there is a concomitant increase in medicaid reimbursements. you see that happening with the current trumpcare agenda?

If that's the case, why do they call them "facility fees"? Why not call them "indigent patient support fees" or something?

PP could provide indigent care if we had access to those fees.

 

[drusso]

again, hospitals see the indigent. no matter how preachy the private practice docs may appear, they will not (nor should they) see the medicaid or free care patient which loses them money. the only way the SOS differential should be eliminated is if there is a concomitant increase in medicaid reimbursements. you see that happening with the current trumpcare agenda?

Everyone know that "facilities fees" are nothing but naked cash transfers from government to hospitals.

 

[Dr. Ice]

So what would one call privately owned ASCs that recieve facility fees?

 

[DrCommonSense]

So what would one call privately owned ASCs that recieve facility fees?

I call it cheaper

 

[SSdoc33]

Everyone know that "facilities fees" are nothing but naked cash transfers from government to hospitals.

you mean the hospitals that take care of the poor? those hospitals..... right. why would we want to give THEM any money? get rid of facility fees and hospitals go bankrupt. city/urban hospitals first. but perhaps thats the goal, right?

you rail against facility fees, but fail to point out a solution like the ones ducttape or i have suggested.

 

[SSdoc33]

If that's the case, why do they call them "facility fees"? Why not call them "indigent patient support fees" or something?

PP could provide indigent care if we had access to those fees.

sounds a lot like you are interested in single payer with that attitude.....

 

[drusso]

you mean the hospitals that take care of the poor? those hospitals..... right. why would we want to give THEM any money? get rid of facility fees and hospitals go bankrupt. city/urban hospitals first. but perhaps thats the goal, right?

you rail against facility fees, but fail to point out a solution like the ones ducttape or i have suggested.

There is no justification for an MD's hospital employer to get a facility for a say EMG, but deny that resource for a self-employed MD seeing the same patient.

 

[hyperalgesia]

sounds a lot like you are interested in single payer with that attitude.....

My worry with single payer is more from a future patient perspective than as a doc. Professionally, it really makes no difference to me in either my VA employed job or my PP, where I spend all my time with insurance crap.

As a patient, I want a lot of choices. I don't want every option for a doc to be a government employed drone who's clicking the boxes all day to get paid. I want to choose between the old timer who keeps only paper charts but has the most experience and the young fellowship trained guy who set up the hospital program. Choices... I want the old timer to have the same incentives and advantages as the hospital employee.

All these BS metrics employed by governmento-programs do NOT make your care better. They make it worse. It's the Big Lie that politicians and media love to push so they can pretend to be your savior.

 

[Ligament]

again, hospitals see the indigent. no matter how preachy the private practice docs may appear, they will not (nor should they) see the medicaid or free care patient which loses them money. the only way the SOS differential should be eliminated is if there is a concomitant increase in medicaid reimbursements. you see that happening with the current trumpcare agenda?

Nor should the hospitals see anybody who will not pay them. We cannot afford to give away healthcare for free at all. I'd be willing to take the hit on US citizen children, but nobody else.

 

[Ducttape]

There is no justification for an MD's hospital employer to get a facility for a say EMG, but deny that resource for a self-employed MD seeing the same patient.

The "justification" is that the self-employed doc can manipulate his patient population and ultimately his payor base so that he can ensure the best financial renumeration per patient.

Technically, a hospital based clinic that gets govnt funding is much more limited and essentially has to take some portion of Medicaid, which obviously pays horribly, is associated with much more denials to services, and plagued with a high no show rate...



So it's like being forced to eat kale... at least sprinkle some bacon on top...


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[SSdoc33]

There is no justification for an MD's hospital employer to get a facility for a say EMG, but deny that resource for a self-employed MD seeing the same patient.

but drusso, you (the proverbial "you" : PP docs) wont see that patient. but the patient needs an EMG. please square that circle for me. again, im looking for a solution, not a complaint.

 

[SSdoc33]

Nor should the hospitals see anybody who will not pay them. We cannot afford to give away healthcare for free at all. I'd be willing to take the hit on US citizen children, but nobody else.

that is a reasonable suggestion. however, when big pharma is raping the system and costs are through the roof, the working poor legitimately cannot afford decent insurance or preventative care. this is where costs have to come down if we are going to provide care on a fee-for service model. some of that cost decrease could come from lowering facility fees. some of it should also care from some amount of care rationing.

 

[SSdoc33]

My worry with single payer is more from a future patient perspective than as a doc. Professionally, it really makes no difference to me in either my VA employed job or my PP, where I spend all my time with insurance crap.

As a patient, I want a lot of choices. I don't want every option for a doc to be a government employed drone who's clicking the boxes all day to get paid. I want to choose between the old timer who keeps only paper charts but has the most experience and the young fellowship trained guy who set up the hospital program. Choices... I want the old timer to have the same incentives and advantages as the hospital employee.

All these BS metrics employed by governmento-programs do NOT make your care better. They make it worse. It's the Big Lie that politicians and media love to push so they can pretend to be your savior.

FWIW, id also prefer to see the old-timer. by a landslide.

 

[VA Hopeful Dr]

that is a reasonable suggestion. however, when big pharma is raping the system and costs are through the roof, the working poor legitimately cannot afford decent insurance or preventative care. this is where costs have to come down if we are going to provide care on a fee-for service model. some of that cost decrease could come from lowering facility fees. some of it should also care from some amount of care rationing.

That is absolutely not true. I can get every category A/B from the USPSTF for astoundingly cheap.

 

[drusso]

but drusso, you (the proverbial "you" : PP docs) wont see that patient. but the patient needs an EMG. please square that circle for me. again, im looking for a solution, not a complaint.

"I" (me, the actual) do see those patients...and end up doing it at a financial loss. I could literally go out business seeing "those" patients all day, but for the hospital down the street its winner because their costs were considered in the payment for those payments. Mine were not.

How is that fair? Square the circle by paying a rate commensurate with the risk and work that THOSE patients bring to the table.

 

[SSdoc33]

That is absolutely not true. I can get every category A/B from the USPSTF for astoundingly cheap.

i think we'd both agree that "preventative care" is not just HCTZ and zantac

 

[SSdoc33]

"I" (me, the actual) do see those patients...and end up doing it at a financial loss. I could literally go out business seeing "those" patients all day, but for the hospital down the street its winner because their costs were considered in the payment for those payments. Mine were not.

How is that fair? Square the circle by paying a rate commensurate with the risk and work that THOSE patients bring to the table.

it isnt fair. completely agree. frankly, you shouldnt see those patients at a loss. you are arguing for increased reimbursements for medicaid patients, when our legislature wants to gut medicaid. this is the direction that many on this board wanted. the whole "repeal obamacare crowd". you cant have your cake and eat it, too.

as far as the SOS differential: it should be changed as addressed above.

 

[Ducttape]

"I" (me, the actual) do see those patients...and end up doing it at a financial loss. I could literally go out business seeing "those" patients all day, but for the hospital down the street its winner because their costs were considered in the payment for those payments. Mine were not.

How is that fair? Square the circle by paying a rate commensurate with the risk and work that THOSE patients bring to the table.

so is the right way to cut the hospital reimbursement rates, or is the better way to improve the amount of money a PP doc gets for seeing these patients?

requesting facility fees get cut will do nothing to help the bottom line of a private practitioner who is seeing these patients.

(fyi not everyone is magnanimous as you. I had the "opportunity" to look at some of the numbers of 2 of the private pain clinics in my area: 3% Medicaid. 0.5% charity care.)

 

[VA Hopeful Dr]

i think we'd both agree that "preventative care" is not just HCTZ and zantac

Oh? So the $23 pap, the $26 colon cancer screening, $7 lipid panel, $12 PSA, $75 Aortic Ultrasound, $40 Chlamydia/gonorrhea testing, $4 glucose testing, $16 Hep C testing, $14 Hep B testing, $24 HIV testing, and $60 DEXA scan aren't preventative care?

 

[SSdoc33]

Oh? So the $23 pap, the $26 colon cancer screening, $7 lipid panel, $12 PSA, $75 Aortic Ultrasound, $40 Chlamydia/gonorrhea testing, $4 glucose testing, $16 Hep C testing, $14 Hep B testing, $24 HIV testing, and $60 DEXA scan aren't preventative care?

those prices may fly in rural north carolina. not so in most places.

and what if the PAP comes back positive? how much is a LEEP procedure? high lipids -- now we have to pay for lipitor. dont get me started on the prices of hepatatis or osteoporosis drugs.

 

[VA Hopeful Dr]

those prices may fly in rural north carolina. not so in most places.

Really? Cause I'm in Columbia, SC (you know, the capital). I've actually seen cheaper in other places (Wichita Kansas, for example, can beat my prices).

I've seen prices matched (or within 10-15%) in Charlotte, Rockport, Maine; Grand Rapids, Michigan; Boston, Kansas City, Huntington Beach (right outside LA), and New Orleans - and those are just doctors I know personally who have negotiated rates like that.

But sure, its obviously just rural locations.

 

[SSdoc33]

Really? Cause I'm in Columbia, SC (you know, the capital). I've actually seen cheaper in other places (Wichita Kansas, for example, can beat my prices).

I've seen prices matched (or within 10-15%) in Charlotte, Rockport, Maine; Grand Rapids, Michigan; Boston, Kansas City, Huntington Beach (right outside LA), and New Orleans - and those are just doctors I know personally who have negotiated rates like that.

But sure, its obviously just rural locations.

you are cherry picking my statements. if i make 10 points, and you play the "i gotcha" card on one of them, it doesnt really get us anywhere.

i will admit that some of the screening tests and generics drugs are affordable.

but the actual CARE usually isnt. how much for a colonoscopy? MOHS procedure for skin cancer? diabetic products?

 

[VA Hopeful Dr]

you are cherry picking my statements. if i make 10 points, and you play the "i gotcha" card on one of them, it doesnt really get us anywhere.

i will admit that some of the screening tests and generics drugs are affordable.

but the actual CARE usually isnt. how much for a colonoscopy? MOHS procedure for skin cancer? diabetic products?

I can get an all-inclusive colonoscopy (anesthesia, GI docs time, post-op visit) for right at $700. PP GI doc with his own endoscopy suite offers great cash prices.

No clue for Mohs as that's not something I refer directly to. But we do have a PP Mohs surgeon here on SDN, let's see if I can't summon @MOHS_01 and see what his prices are...

I can get a glucometer for $16 and 50 test strips for $10. Lancets, I can get a box of 100 for $2. I can get 100 insulin syringes with needles for $10.

The point I'm trying to make here is that routine health care, especially primary care, can be had for a lot less than anyone realizes. Insurance/hospitals make it more expensive than it should be, bottom line.

 

[SSdoc33]

I can get an all-inclusive colonoscopy (anesthesia, GI docs time, post-op visit) for right at $700. PP GI doc with his own endoscopy suite offers great cash prices.

No clue for Mohs as that's not something I refer directly to. But we do have a PP Mohs surgeon here on SDN, let's see if I can't summon @MOHS_01 and see what his prices are...

I can get a glucometer for $16 and 50 test strips for $10. Lancets, I can get a box of 100 for $2. I can get 100 insulin syringes with needles for $10.

The point I'm trying to make here is that routine health care, especially primary care, can be had for a lot less than anyone realizes. Insurance/hospitals make it more expensive than it should be, bottom line.

thats awesome that you actually know the prices and can provide relatively inexpensive primary care. seriously. really cool. there is no reason that a tylenol from a hospital should cost 10 bucks.

the fact remains that many things needed in both primary and secondary care are exorbitant in the current system. i agree that in some instances, office based care is cheaper and better.

 

[VA Hopeful Dr]

thats awesome that you actually know the prices and can provide relatively inexpensive primary care. seriously. really cool. there is no reason that a tylenol from a hospital should cost 10 bucks.

the fact remains that many things needed in both primary and secondary care are exorbitant in the current system. i agree that in some instances, office based care is cheaper and better.

You've hit the nail on the head right there.

We can all agree that some things are just always going to be expensive. Nothing we realistically can do is going to make a CABG or an organ transplant cheap. That's the sort of stuff insurance is designed for - super expensive stuff that is also somewhat rare. You car insurance doesn't pay for oil changes, your homeowner's insurance doesn't pay for a water heater. Why should health insurance pay for something that should be pretty inexpensive (primary care)?

 

[Ducttape]

I can get an all-inclusive colonoscopy (anesthesia, GI docs time, post-op visit) for right at $700. PP GI doc with his own endoscopy suite offers great cash prices.

No clue for Mohs as that's not something I refer directly to. But we do have a PP Mohs surgeon here on SDN, let's see if I can't summon @MOHS_01 and see what his prices are...

I can get a glucometer for $16 and 50 test strips for $10. Lancets, I can get a box of 100 for $2. I can get 100 insulin syringes with needles for $10.

The point I'm trying to make here is that routine health care, especially primary care, can be had for a lot less than anyone realizes. Insurance/hospitals make it more expensive than it should be, bottom line.

Im missing your point.

are you asking for people to pay for these medical "treatments" out of their own pocket?

irrespective of your billing costs, these may still be woefully out of reach of a significant proportion of people. remember that your minimum wage worker in SC is only making $7.25/hour.

your pap smear is 3 hours of wages for said worker. that might be the equivalent - to you - of $600+... would you have concerns if you had to pay for $600 in equivalent wages for a "routine preventative test"?

 

[VA Hopeful Dr]

Im missing your point.

are you asking for people to pay for these medical "treatments" out of their own pocket?

irrespective of your billing costs, these may still be woefully out of reach of a significant proportion of people. remember that your minimum wage worker in SC is only making $7.25/hour.

your pap smear is 3 hours of wages for said worker. that might be the equivalent - to you - of $600+... would you have concerns if you had to pay for $600 in equivalent wages for a "routine preventative test"?

I don't think 3 hours of wages every 3 years is too much to ask to detect cancer...

 

[Ducttape]

so you would be willing to spend $600 for routine testing?

now add on to what you also call preventative medicine: "Oh? So the $23 pap, the $26 colon cancer screening, $7 lipid panel, $12 PSA, $75 Aortic Ultrasound, $40 Chlamydia/gonorrhea testing, $4 glucose testing, $16 Hep C testing, $14 Hep B testing, $24 HIV testing, and $60 DEXA scan aren't preventative care?"

ignoring aortic ultrasound and DEXA scans (and replace chlamydia/gonorrhea testing with EKG)... lets say every 3 years you recommend the rest

every 3 years, for testing alone, you recommend over 3 days worth of wages for your preventative testing. would you pay the equivalent of roughly $5000 (to you) for preventative routine maintenance testing every 3 years?

remember, you have significantly more disposable income than these individuals. what is inexpensive to you - forgoing a latte, for example - is significantly different to those making a lot less than us.

 

[Ligament]

that is a reasonable suggestion. however, when big pharma is raping the system and costs are through the roof, the working poor legitimately cannot afford decent insurance or preventative care. this is where costs have to come down if we are going to provide care on a fee-for service model. some of that cost decrease could come from lowering facility fees. some of it should also care from some amount of care rationing.

That makes sense. I think we could make the biggest decrease in costs by initiating nationwide tort reform; lab tests, imaging tests, diagnostic tests would drop 50% overnight as CYA medicine would die. What % of tests you order are really, seriously needed vs. CYA orders?

 

[VA Hopeful Dr]

so you would be willing to spend $600 for routine testing?

now add on to what you also call preventative medicine: "Oh? So the $23 pap, the $26 colon cancer screening, $7 lipid panel, $12 PSA, $75 Aortic Ultrasound, $40 Chlamydia/gonorrhea testing, $4 glucose testing, $16 Hep C testing, $14 Hep B testing, $24 HIV testing, and $60 DEXA scan aren't preventative care?"

ignoring aortic ultrasound and DEXA scans (and replace chlamydia/gonorrhea testing with EKG)... lets say every 3 years you recommend the rest

every 3 years, for testing alone, you recommend over 3 days worth of wages for your preventative testing. would you pay the equivalent of roughly $5000 (to you) for preventative routine maintenance testing every 3 years?

remember, you have significantly more disposable income than these individuals. what is inexpensive to you - forgoing a latte, for example - is significantly different to those making a lot less than us.

So basically you think people shouldn't have to pay anything for any health care, is that what you're getting at?

What about transportation? Gas and upkeep of a car is much more expensive than preventative health care and vital for the vast majority of Americans since we're not a pedestrian country. And clothes? Clothing is more expensive than most preventative health care and nudity is frowned upon.

Plus, most of the stuff I listed isn't necessary for most people. No one needs both a pap and a PSA. Aortic ultrasound is only needed one time in a life. Same with Hep C testing assuming you don't do IV drugs. HIV is recommended only once unless you're at high risk, same with Hep B.

So really, for a woman under age 60 you're paying for a pap every 3 years (so about $8/year) and Hep C testing one time. That yearly glucose once you hit age 40 at $4 isn't a huge deal either.

 

[lonelobo]

I always love when affluent doctors argue about why a certain population is not entitled to healthcare......

 

[VA Hopeful Dr]

I always love when affluent doctors argue about why a certain population is not entitled to healthcare......

Actually, my current pay puts me just above the median household income, and that was after 18 months of not paying myself at all.

 

[lonelobo]

Actually, my current pay puts me just above the median household income, and that was after 18 months of not paying myself at all.

Really ...sounds like you need a better paying gig

 

[VA Hopeful Dr]

Really ...sounds like you need a better paying gig

Meh, starting a practice like this is always slow going. I also have way more space than I currently need but it will make bringing on other doctors incredibly easy.

 

[Ligament]

I always love when affluent doctors argue about why a certain population is not entitled to healthcare......

Nobody is entitled to healthcare at all. As I said I'd be happy to contribute my tax dollars to US citizen children in need. The inabiliy of their parents to purchase healthcare is not the child's fault.

 

[lonelobo]

Nobody is entitled to healthcare at all. As I said I'd be happy to contribute my tax dollars to US citizen children in need. The inabiliy of their parents to purchase healthcare is not the child's fault.

Well I disagree, and so does the majority of the Industrialized world.......but we've been through this before

 

[drpainfree]

Nobody is entitled to healthcare at all. As I said I'd be happy to contribute my tax dollars to US citizen children in need. The inabiliy of their parents to purchase healthcare is not the child's fault.

actually, NOBODY is ENTITLED to ANYTHING in life unless it involves nobody else but oneself.

You are entitled to freedom of speech until your entitlement infringes upon someone else.

With commodities, you are entitled to it only when there is no lack of resources to accommodate everyone else who is equally entitled to the same resource. When there's limited resource, realistically speaking, someone else will always get more resources at better qualities, and quicker rate. It has been true in human history, regardless how liberals will think otherwise.

To brain wash general public with the notion healthcare is a human right, and creating this entitlement notion, will only further devalue the quality of healthcare.

This is why Medicaid patients rarely do better in terms of pain management. The care is cheap, and the result is expected dismal.

 

[DrCommonSense]

actually, NOBODY is ENTITLED to ANYTHING in life unless it involves nobody else but oneself.

You are entitled to freedom of speech until your entitlement infringes upon someone else.

With commodities, you are entitled to it only when there is no lack of resources to accommodate everyone else who is equally entitled to the same resource. When there's limited resource, realistically speaking, someone else will always get more resources at better qualities, and quicker rate. It has been true in human history, regardless how liberals will think otherwise.

To brain wash general public with the notion healthcare is a human right, and creating this entitlement notion, will only further devalue the quality of healthcare.

This is why Medicaid patients rarely do better in terms of pain management. The care is cheap, and the result is expected dismal.

To be fair, Medicaid patients rarely do better with ANYTHING including liver transplants, stents, obesity, etc.

 

[lonelobo]

6 promises Trump has made about health care

Here is what the president thinks on the issue

“We’re going to have insurance for everybody,” Trump said in an interview with The Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

 

[lonelobo]

Nobody is entitled to healthcare at all. As I said I'd be happy to contribute my tax dollars to US citizen children in need. The inabiliy of their parents to purchase healthcare is not the child's fault.

So what is cutoff on paying for children, 8, 10 , 18, 21?

 

[hyperalgesia]

I always find it strange that liberals never blame their city or state governments for not providing "free" services and stuff to people. The only thing they want from their local governments is to demand stuff from the federal govt.

Why don't Californians blame the governor and legislature and the San Francisco Mayor for "Letting kids die on the street because of Medicaid"? Instead people flock to and worship future gov Gavin Newsom and praise him for mocking Trump and complaining about how little money California is given by OTHER STATES. It seems pathetic to me.