Medicare for all — net costs

[FLS]

Am I brainwashed or is it possible that this thread title should be "Medicare-for-all----net-savings"...?

[Sirshredalot]

My doctor practice in Tahoe has a bunch of assistants, nurses, biking clerks, receptionists, at least 15 admin.

When I was in France last year, the clinic I went to had about 8 doctors and one admin.

There's a lot of room to cut costs, but there is no incentive to do it.

Sent from my Moto G (5) Plus using TGR Forums mobile app

The administrative overhead is an artifact of our fucked up insurance scheme.

What ncskier is missing is that in a single-payer system where everyone takes Medicare reimbursement rates, the docs retain 80 or 90 percent of their current take-home and he gets laid off, with the patients and the docs splitting the savings. It's not the docs who are out on their asses in that transition, it's the administrative overhead that gets axed.

[Garth Bimble]

The administrative overhead is an artifact of our fucked up insurance scheme.

What ncskier is missing is that in a single-payer system where everyone takes Medicare reimbursement rates, the docs retain 80 or 90 percent of their current take-home and he gets laid off, with the patients and the docs splitting the savings. It's not the docs who are out on their asses in that transition, it's the administrative overhead that gets axed.

Please explain how this works...I'd love to hear it.

[XXX-er]

how much time does an md spend dicking around with insurance companies ?

I heard it could be 2 hrs out of a 10 hr day?

[Garth Bimble]

how much time does an md spend dicking around with insurance companies ?

I heard it could be 2 hrs out of a 10 hr day?

Unless it's a very small practice MD's don't dick around with insurance companies or other 3rd party payers (the federal gov't) which is why you have clerical people. Do you really want your doc worrying about Medicare documentation while he's lancing your hemorrhoid?

[XXX-er]

well the clerical people ^^ don't work for nothing

[Tri-Ungulate]

The dicking around is mostly indirect, in the form of endless documentation, although IME there are increasingly frequent episodes where docs have to deal directly with the insurance company for denied treatments, which can often take up considerable amounts of time. I would say that 20% of needless dicking aroud work could easily be a reasonable estimate in terms of dealing with our current system.

On top of that, there are the clerical people whose job it is to directly dick around with the insurance dicks. What I'm talking about is the above and beyond dicking around docs have to do despite the dedicated dicking around staff.

[summit]

There's armies of admin people to ensure compliance with CMS (Center for Medicare/Medicaid Services), to deal with their auditors, to code charts so that Medicare will pay extra, people who make sure doctors write their notes so that medicare/medicaid pays more, make sure all the boxes are checked by the nurses for reimbursement and regulatory compliance, shuffle the e-papers, handle reimbursement, fight payors... yes having additional insurance companies adds some more admin overhead over the government, but probably not that much more. The entire CMS/private insurance system causes massive admin overhead, and it isn't just the private insurance companies that are to blame.

[CantDog]

[QUOTE=ncskier;5421450]
Think of it this way, would you prefer the Federal government mandate everyone must purchase a car from Ford or GM or build a mass transit system that is essentially subsidized and you could ride anywhere for "free". We got the mandate to buy the car.
http://time.com/money/4839017/judy-f...lionaire-epic/

To be fair, it's like mandating that everyone buy a ferrari not a ford. Epic is great, but where the govt screwed up was not mandating that every hospital use CPRS. Free. Well-developed and with a long track record of being effective.

[Meanfruit]

Can't get rid of McConnell soon enough, so we can get back to...


"DEMOCRATIC SUPERDELEGATE, IN ROOM FULL OF HEALTH INSURANCE EXECUTIVES, LAUGHS OFF PROSPECT OF SINGLE PAYER"


"ACTIVISTS ACROSS THE COUNTRY have provided real momentum to the idea of a single-payer health care system, pressing the issue in California and among leading figures in the Democratic Party.


The mere prospect of single payer, however, has elicited swift derision from some corners of the party, with Dick Gephardt, the former Democratic House minority leader, laughing off the idea at a health insurance conference earlier this month.


“Not in my lifetime,” scoffed Gephardt, when asked if the United States will ever adopt such a system.


Gephardt, who serves as a Democratic “superdelegate” responsible for choosing the party’s presidential nominee, was asked about the possibility of single payer at the Centene Corporation annual investor day conference at The Pierre, a ritzy five-star hotel in New York City."

Looking forward, to getting back, to dick.

And I was feeling so good about the day.... Time to reboot!

[Meanfruit]

The Canadian Health Act defines what health care services are covered under the Act. Services outside of the Act are not covered (but may be provided under the provincial authority that provides insurance under the federal Act). This includes dental, vision, PT, prescription drugs, and some elective treatment/surgery like cosmetic surgery. For those services, private insurance is available. Some provinces (like BC and AB) charge a premium for health care, but treatment can not be denied if your account is in arrears. You can also not be denied treatment when visiting another province, subject to a waiting period for new residents that are in the process of moving.

BC Government is doing away with the premium. Alberta to follow suit, I'd guess

[Mazderati]

I know physicians who refuse to see Medicare patients and physicians who take every Medicare patient that walks in. They'are all doing just fine.

[XXX-er]

my buddy neglected to pay the monthly premium cuz he went self employed amount ^^and broke his leg skiing, they just told him to start paying and fixed his leg

I could be wrong but I think in BC the MD just bills directly

[Garth Bimble]

[QUOTE=CantDog;5421971]

Think of it this way, would you prefer the Federal government mandate everyone must purchase a car from Ford or GM or build a mass transit system that is essentially subsidized and you could ride anywhere for "free". We got the mandate to buy the car.
http://time.com/money/4839017/judy-f...lionaire-epic/

To be fair, it's like mandating that everyone buy a ferrari not a ford. Epic is great, but where the govt screwed up was not mandating that every hospital use CPRS. Free. Well-developed and with a long track record of being effective.

I don't know anything about CPRS, never seen it. What makes Epic so popular though is that when many providers implemented EHR's they did so piece meal so now they have different systems for different applications and none of them work together. Epic replaces some of these but it's also capable of integrating many of the legacy systems so most, if not all data is now available in one place.

Epic isn't cheap but it's being implemented all over the place including the provider that I work for which is one of the largest and most respected, if not the most respected health care provider in the world. I have a hard time believing that they would choose Epic over another system that's free if they felt the free system was a viable solution.

[summit]

CPRS was good... 20 years ago. Its archaic dog shit by modern standards. Truly crap from the front end to the back.

Cerner was a great choice for DOD/VA instead of progressing with the idiotic internally developed CPRS replacement that was outdated while still being developed and didn't meet half the needs. I like Epic too. I am familiar with about 10 EHRs.

Seriously implying CPRS should be universally adopted is the height of ignorance. It's like Windows 3.1 running on DOS (VISTA).

[CantDog]

[QUOTE=Garth Bimble;5422031]

I don't know anything about CPRS, never seen it. What makes Epic so popular though is that when many providers implemented EHR's they did so piece meal so now they have different systems for different applications and none of them work together. Epic replaces some of these but it's also capable of integrating many of the legacy systems so most, if not all data is now available in one place.

Epic isn't cheap but it's being implemented all over the place including the provider that I work for which is one of the largest and most respected, if not the most respected health care provider in the world. I have a hard time believing that they would choose Epic over another system that's free if they felt the free system was a viable solution.

CPRS is the front end of the VistA VA system that is available for free. Integrated across inpatient, outpatient, home based and nursing facilities. I think it never took off outside of govt use in this country(but used or built upon for foreign EMRs) because its front end is not all that attractive and heavily text based. Plus it doesn't have a dedicated group of people signing its praises and touting it as the latest and greatest.

Now having used 10 EMRs at last count, epic is certainly the most attractive and intuitive EMR from a provider standpoint. Now that I spend some of my time doing health services research I've been impressed with the amount of accessible data in VistA/CPRS and ease of extracting info.

No health system will ever willingly switch to use VistA, but the fact that the largest healthcare system in the US has been using a continually evolving EMR for over 30 years counts for something.

[summit]

Yes the data warehouse at VA is a treasure trove

[CantDog]

CPRS was good... 20 years ago. Its archaic dog shit by modern standards. Truly crap from the front end to the back.

Cerner was a great choice for DOD/VA instead of progressing with the idiotic internally developed CPRS replacement that was outdated while still being developed and didn't meet half the needs. I like Epic too. I am familiar with about 10 EHRs.

Seriously implying CPRS should be universally adopted is the height of ignorance. It's like Windows 3.1 running on DOS (VISTA).

If CPRS was adopted 20 years ago and allowed to grow outside the VA it would surely be better. It may be archaic in that it doesn't have fancy colors maybe, but in actual use from a clinical and research standpoint it's certainly not. Changing to Cerner is a terrible idea.

[summit]

If CPRS was adopted 20 years ago and allowed to grow outside the VA it would surely be better. It may be archaic in that it doesn't have fancy colors maybe, but in actual use from a clinical and research standpoint it's certainly not. Changing to Cerner is a terrible idea.

Woulda coulda shoulda... But it wasn't and its far too late. There's a lot more than pretty colors to something like epic. You sit in on morbidity and mortality reviews and see how shit functionality in CPRS leads to missed critical labs or cancer.

Trying to update a default order set at VA requires highly technically minded Informaticists and time. EPIC or Cerner the direct care provider makes their own

Cernef well implemented is the easiest most efficient EHRs for the hospital provider that I have ever seen. Adds hours to a nurses or doctors day vs CPRS and whatever shit bolt on electonic flow sheet the VISN purchased (most are still on paper outside of ICU, so, no data for you!).

Sure for research I would rather be using the VA CDW and MSSQL and use SPSS (but you might have to use PL/SQL to access flowsheet data from a separate database) vs dealing with Epic which is built on MUMPs even though there's a plenty of ability to use SQL. Yea Epic reporting workbench is not so hot, but it does work. Try having your end users get data from CPRS? Command line for prewritten shit in VistA! Yay! Said nobody ever...

[Tri-Ungulate]

LOL, having used CPRS (which I liked) and now stuck with Cerner, I gotta disagree, IMO at least. Cerner sucks shit. Completely. Totally. Unequivocally. We have our own regular M&M's on how bad shit went down because of yet another Cerner fuckup.

It is so bad that the U of U, after spending a shitload buying into Cerner, spent another shitload getting out of it to move to Epic, which from what I hear is better (but not having used it myself). Some pretty sobering studies on how much time and $ lost when MDAnderson switched to Cerner. Not a fan.

[summit]

A lot depends on your setup and configuration. I used CPRS on the front and back end. I now Epic and Cerner. The Cerner implementation I use bedside is truly outstanding. Some of that has to do with the facility running an excellent show with top notch support. Cerner was the biggest market share in the world until Epic overtook it in the last year or two! They didn't get there by sucking.

I don't know what sort of insane fuckup one has to do to have Cerner worse than CPRS. Perhaps it was an archaic version? HCA runs an ancient version of Meditech they own the code for that is more reminiscent of VistA and they were the only HCWs who came to the VA and said "oh wow, this is better than what I came from." Everyone else came to the VA wondered if they'd gone through a fucking timewarp while getting CPRS training.

I deal with Epic on the front and back end. It's a good system. Again, it has to have excellent support. I've been involved in 6 EHR go-lives. If a hospital system has insufficient structure, culture, analysts and informaticists, even a good EHR will suck!

... if there is a good EHR:

Best-Practice Popups will tire you...

... 30 clicks for an Ambien!

[Kenny Satch]

... 30 clicks for an Ambien!

Brilliant video postings.
The bald doctor makes a lot of sense

[ncskier]

I kind of half jokingly tell clients that the hundreds of millions spent on epic will look foolish in 5-10 years, when a perfectly functioning ehr system is completely free and cloud based with a hospitals $100 year subscription to amazon prime for business.

[evdog]

Interesting article I saw today on how large hospital systems use market share and contracts to hinder competition and keep costs high

https://www.msn.com/en-us/money/heal...cid=spartandhp

[summit]

Interesting article I saw today on how large hospital systems use market share and contracts to hinder competition and keep costs high

https://www.msn.com/en-us/money/heal...cid=spartandhp

Remember, the Affordable Care Act was designed to eliminate small practice and make hospital systems bigger because surely that would be more efficient!