How does use of Omidria get reimbursed?

[eyeguyhopeful]

I wonder if ASCs get reimbursed if they decide to use Omidria on patients who may potentially have IFIS?

At our VA, we use it often, but of course the VA just prints money.

Are owners of ASC losing money when they use Omidria?

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[hello lady!]

I wonder if ASCs get reimbursed if they decide to use Omidria on patients who may potentially have IFIS?

At our VA, we use it often, but of course the VA just prints money.

Are owners of ASC losing money when they use Omidria?

It's a pass-through cost to insurance. I believe they have gotten their pass-through status extended twice so far. Otherwise, they'd have to drop the price.

 

[Dusn]

From what I’ve hear, the VA gets Omidria at a very very steep discount (negotiated price).

They negotiated brand name durezol down to ~$10 and anti-VEGF injections for near half of what is paid by Medicare and elsewhere.

 

[dantt]

From what I’ve hear, the VA gets Omidria at a very very steep discount (negotiated price).

They negotiated brand name durezol down to ~$10 and anti-VEGF injections for near half of what is paid by Medicare and elsewhere.

Imagine what would happen if medicare could negotiate the pricing for drugs!

 

[hello lady!]

Imagine what would happen if medicare could negotiate the pricing for drugs!

More money for the private Medicare Advantage plans?

 

[Doc320]

Imagine what would happen if medicare could negotiate the pricing for drugs!

Imagine what would happen if Medicare was required to negotiate the reimbursement to doctors with the doctors forming a national union

 

[dantt]

Imagine what would happen if Medicare was required to negotiate the reimbursement to doctors with the doctors forming a national union

Remember what happened to the air traffic controllers?

 

[Doc320]

Remember what happened to the air traffic controllers?

What happened to them?
They were fired because of a law banning federal employees from striking. If doctors were allowed to negotiate with Medicare as a union, they would not be banned from striking and would not be federal employees.

Those who support universal healthcare often want a system where doctors ARE federal employees, like the British NHS.

What happened to the air traffic controllers? Some applied to be rehired and WERE rehired. Others changed their line of work. The air traffic controller ranks did not recover until TEN years later.

Look at the pilots union. An American Airlines captain can make $590k per year and work about 80 hours a month. They have limitations in hours so no need to take hospital call and stay up a night then have to see patients the next day. If they fly a red eye flight, they get to sleep upon arrival. A pilot often has a career of 43 years. A doctor rarely has a 40 year career. If the doctor retires at 65, they might have a career as short as 29 years if they went to medical school without any delay but did a cardiothoracic fellowship.

Basically a union can help members if the union leadership are not a bunch of lazy or corrupt fat cats. Individual doctors are at the mercy of Medicare, hoping that they will not get their heads cut off.

 

[dantt]

What happened to them?
They were fired because of a law banning federal employees from striking. If doctors were allowed to negotiate with Medicare as a union, they would not be banned from striking and would not be federal employees.

Those who support universal healthcare often want a system where doctors ARE federal employees, like the British NHS.

What happened to the air traffic controllers? Some applied to be rehired and WERE rehired. Others changed their line of work. The air traffic controller ranks did not recover until TEN years later.

Look at the pilots union. An American Airlines captain can make $590k per year and work about 80 hours a month. They have limitations in hours so no need to take hospital call and stay up a night then have to see patients the next day. If they fly a red eye flight, they get to sleep upon arrival. A pilot often has a career of 43 years. A doctor rarely has a 40 year career. If the doctor retires at 65, they might have a career as short as 29 years if they went to medical school without any delay but did a cardiothoracic fellowship.

Basically a union can help members if the union leadership are not a bunch of lazy or corrupt fat cats. Individual doctors are at the mercy of Medicare, hoping that they will not get their heads cut off.

Didn't know independent contractors / businesses could form a union. Typically it's employees who come together to form unions.

 

[Doc320]

Didn't know independent contractors / businesses could form a union. Typically it's employees who come together to form union

They can but Medicare will not negotiate with such union. One union in California permits individual doctors to join the union. Such union should be able to negotiate fees. If Medicare does budge, then Medicare patients can see their family doctor or OB-GYN for their cataract or AMD, assuming the union doesn't cover family medicine physicians and gynecologists.

Another issue is whether it's fair that Medicare can abuse doctors with little recourse. No, it's not fair. That's a major problem with a universal healthcare system. The single payor could and would abuse doctors with little recourse.

 

[MstaKing10]

Didn't know independent contractors / businesses could form a union. Typically it's employees who come together to form unions.

What if doctors working for PE owned practices decided to unionize? They are employees after all.

 

[Doc320]

What if doctors working for PE owned practices decided to unionize? They are employees after all.

Such unionization would be ineffective to increase Medicare reimbursements because the number of PE employed doctors is too small. However, if the membership of the American Academy of Ophthalmology, American College of Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, AAOS (Ortho), AUA (Urology), ACC (Cardiology) were to band together to form a union, perhaps reimbursement could be negotiated or industrial action taken. If you have a broken hip, are you going to see an optometrist or naturopath?

 

[ayeball]

Doctors might have the capacity to unite, but the government will retain the power to undermine their collective influence. See residency system.


In Belgium, the constitution enshrines the right to collective bargaining and, as a part thereof, also the right to strike.8 However, the Essential Services Law requires the medical industry to continue to provide services even in the event of a strike in accordance with decisions made by joint committees of employees and employers.9

The legal position around the world regarding physicians’ strikes - IMA - Israel Medicine Association

The legal position around the world regarding physicians’ strikes - IMA - Israel Medicine Association

www.ima.org.il

Belgium: Physician, See Thyself

After two weeks of a medical strike that involved 85% of Belgium's 12,000 physicians and dentists, the nation showed no serious ill effects. Hundreds of doctors remained defiantly self-exiled...

content.time.com

Physician Resistance and the Forging of Public Healthcare: A Comparative Analysis of the Doctors’ Strikes in Canada and Belgium in the 1960s

Organised medicine in a number of advanced industrial countries resisted the post-war trend toward more state involvement in the funding and organisation of medical care. While there were eight doctors’ strikes during the peak of reform efforts ...

www.ncbi.nlm.nih.gov