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Posted on 2/22/17 at 2:41 pm to roadGator
Why would a hospital set it's subscription rates at a level that they do not think is profitable???
Posted on 2/22/17 at 2:44 pm to Hopeful Doc
I think the only way to do this is to make the hospital systems public with tax payer money. It would be similar to the public school systems. Basic health insurance could remain private.
I'm against anything like that bc it's such a slippery slope and hospital quality would go down over time. Once hospital service becomes an entitlement it would be taken advantage of. Funding would always be short and politicians would use it as another way to increase taxes.
I'm against anything like that bc it's such a slippery slope and hospital quality would go down over time. Once hospital service becomes an entitlement it would be taken advantage of. Funding would always be short and politicians would use it as another way to increase taxes.
Posted on 2/22/17 at 2:45 pm to Hopeful Doc
quote:
Why do you oppose a hospital billing for services rendered?
Because the government is a poor shopper and what they pay the hospitals sets the floor for the rest of us.
I bet you a majority of hospital administrators would prefer subscription revenue to fee for service. Their cost are mostly fixed and fixing the income stream would be much more efficient for them and will allow customers to better shop for hospital services.
You act like no one can operate on subscription services. That is crazy. There are unforeseen cost to every subscription based business.
You probably do not want it to be easier for consumers to shop healthcare.
Posted on 2/22/17 at 2:47 pm to tigereye58
quote:
I think the only way to do this is to make the hospital systems public with tax payer money. It would be similar to the public school system
Why do you think that??
You don't think Oschner and LOL and all the others can compete??
Posted on 2/22/17 at 3:09 pm to I B Freeman
quote:
Their cost are mostly fixed
Got a link there? Costs are far from fixed and highly variable on the number of patients present at any one time, which fluctuates week to week, month to month and year to year. Staffing is constantly moved to attempt to match costs and revenues, and you're talking about an industry that currently operates at about a 1% profit margin.
quote:
Because the government is a poor shopper and what they pay the hospitals sets the floor for the rest of us.
Your stance: the government currently sets the floor for pricing and doesn't do a good job of it, so the government should mandate that you can't pay for only what you use anymore, and an entire third party industry should be dissolved...Am I understanding you correctly?
quote:
You act like no one can operate on subscription services. That is crazy. There are unforeseen cost to every subscription based business.
I am not acting like no one can operate on a subscription based service. I'm arguing that hopsitals in the USA should not operate on a subscription service because it's a poor plan.
We agree that the billing/reimbursement scheme that exists today is, at best, silly. If you're going to make radical government-centric change, why not suggest that insurance companies have to reimburse providers and hospitals the same for any given charge? That is, hospital admission done by me for Blue Cross at Our Lady of Example gets $200 but when done by Hopeless Doc at State Owned hospital, blue Cross now only pays $180. Wouldn't leveling the reimbursement structure, allowing physicians/hospitals to share and discuss fee schedules, and allowing a published, up-front "cash pay" price in an essential "menu book" to patients be preferred?
quote:
You probably do not want it to be easier for consumers to shop healthcare.
No. I would love it, actually. Good guess, though. Subscription-based clinic care is good. But hospital care? I don't see it as good or sustainable.
Posted on 2/22/17 at 3:10 pm to I B Freeman
quote:
Why would a hospital set it's subscription rates at a level that they do not think is profitable
Why do you think they have the ability to set rates that are profitable?
Posted on 2/22/17 at 3:13 pm to I B Freeman
Why do I think that what you are proposing is basically capitation?
Because it is more or less.
But hey, if this happens I'm going to start a TPA to administer the billing of these subscriptions and farm out all the customer service to India.
Because it is more or less.
But hey, if this happens I'm going to start a TPA to administer the billing of these subscriptions and farm out all the customer service to India.
Posted on 2/22/17 at 4:20 pm to roadGator
quote:
Why do you think they have the ability to set rates that are profitable?
They can set their own rates. Who said they couldn't?
Posted on 2/22/17 at 4:22 pm to I B Freeman
Well, having done some medical underwriting early in my career, I'm saying that they couldn't.
They'd have to hire staff to do it or pay consultants. That's exactly what insurance companies do except for in your scenario, each hospital would have to have an underwriting department. Sounds less efficient.
They'd have to hire staff to do it or pay consultants. That's exactly what insurance companies do except for in your scenario, each hospital would have to have an underwriting department. Sounds less efficient.
Posted on 2/22/17 at 4:28 pm to Hopeful Doc
quote:
Got a link there? Costs are far from fixed and highly variable on the number of patients present at any one time, which fluctuates week to week, month to month and year to year. Staffing is constantly moved to attempt to match costs and revenues, and you're talking about an industry that currently operates at about a 1% profit margin.
All of that is BS.
Anyone that can read financial statements can recognize a hospital's cost are mostly fixed. But here is a link even a doctor can understand.
LINK
quote:
Your stance: the government currently sets the floor for pricing and doesn't do a good job of it, so the government should mandate that you can't pay for only what you use anymore, and an entire third party industry should be dissolved...Am I understanding you correctly?
No you are not.
All of those things have been conjured up in your mind. BUT it would be wonderful if the cost of an entire industry were dissolved but that is not the case.
quote:
If you're going to make radical government-centric change,
What are you talking about?
Posted on 2/22/17 at 4:36 pm to roadGator
quote:
They'd have to hire staff to do it or pay consultants. That's exactly what insurance companies do except for in your scenario, each hospital would have to have an underwriting department. Sounds less efficient.
You do not think their cost are mostly fix so you really don't have any idea.
I remember when they priced care by the day. My first policy paid $100 a day for hospitalization. That all changed when medicare went fee for service thinking it efficient. Boy was they wrong. That simply opened the door to government mandated pricing like we have today. No provider that takes medicare can charge LESS to any other buyer of care than they charge medicare. So what do providers do? they beg, lobby, bribe, to get their reimbursements higher raising all our cost as the government pays more.
There is no market reason that healthcare cost have exceeded the rate of inflation now for twenty years.
Removing the government from direct purchasing of healthcare will stop that increase.
It wouldn't bother me if all the health care was delivered by subscription making it very easy to shop.
Posted on 2/22/17 at 4:45 pm to I B Freeman
quote:
You do not think their cost are mostly fix so you really don't have any idea.
Um, I don't? Weird.
There is still some pricing by the day depending on what the service is.
quote:
There is no market reason that healthcare cost have exceeded the rate of inflation now for twenty years.
Um, there are very good reasons. Maybe not acceptable to you though. I would tend to agree.
The government doesn't affect how I purchase healthcare direclty other than ACA bullshite.
Your subscriprtion scenario needs some more thought.
Will you have a pharma sub, a radiologist sub, a surgeon sub, mental health sub, etc.
That's lots of subscriptions unless I'm not understanding you.
Posted on 2/22/17 at 4:54 pm to roadGator
quote:
Um, there are very good reasons.
Name one beside government increase in reimbursement.
One.
quote:
Will you have a pharma sub, a radiologist sub, a surgeon sub, mental health sub, etc.
I will not have anything. The providers can offer whatever subscription cover they want and I can pick and choice between providers.
One might say for "X per month you get basic hospital usage and that includes a,b,c" if you want ER services it is this much more and on and on. Nothing is keeping the providers from offering cash services too.
Until the cost are attacked and doctors quit being paid so much and hospitals so much and drug companies so much then cost will not go down. If a GP is seeing 1000 patients a year now and making $300k we need him to see 1200 or take $250k for 1000. The best way to do that is to change the pricing model and get government out of the direct purchasing of health care services and let the people receiving the service do the shopping.
By encouraging moving to subscription based pricing health care shopping will be much easier and the cost to subsidize poor people to government will be easier to define.
Posted on 2/22/17 at 4:54 pm to I B Freeman
quote:
for example, a rider letting you go to a specialized hospital if your subscribed hospital did not offer the care you needed.
In order to get a rider you would have to have an insurance policy for which something could "ride" upon so I'm not sure what you mean here.
Posted on 2/22/17 at 4:55 pm to I B Freeman
quote:
hospitals so much
Wait. I thought the point of the sub was to get them more money.
I'm so confused.
Posted on 2/22/17 at 4:56 pm to roadGator
quote:
In order to get a rider you would have to have an insurance policy for which something could "ride" upon so I'm not sure what you mean here.
Yes you would need an insurance policy if you want to insure risks your subscription does not cover.
What is wrong with that?
Posted on 2/22/17 at 4:56 pm to I B Freeman
quote:
By encouraging moving to subscription based pricing health care shopping will be much easier
So instead of one policy that coverse everything, I would have to shop for many different and separate subscription services? I'm not seeing the improvement in the consumer experience.
Posted on 2/22/17 at 5:00 pm to I B Freeman
You used rider in a way that we in the industry don't. You start with an insurance policy and you add riders to that policy though that's not really the case much any longer.
I don't want to have to shop for 6 different subscriptions individually to get "full" coverage. That is definitely not going to fly with consumers based on my experience. Hell, no one reads the policy documents they have now.
I don't want to have to shop for 6 different subscriptions individually to get "full" coverage. That is definitely not going to fly with consumers based on my experience. Hell, no one reads the policy documents they have now.
Posted on 2/22/17 at 5:02 pm to roadGator
quote:
I'm not seeing the improvement in the consumer experience.
I could say a lot of things here.
I will just leave it with this--you prefer the consumer going to the hospital not knowing what a single thing cost and see that as better than a couple or three subscriptions?
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