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Posted on 6/23/19 at 12:44 am to Cosmo
You’re a doctor?
Posted on 6/23/19 at 3:38 am to RealityTiger
quote:
Who the frick comes up with the pricing for medical procedures?
Sorry it took so long, on call tonight.
Pricing or payment? 2 different things
Payment is set by Medicare. Every year they figure out how many RVUs (relative value unit) every procedure will be. The amount of RVUs is usually relatively flat, so some things increase, others decrease. They also figure out their budget for the year, and therefore the amount you get per RVU. There are multipliers for a host of things, like region, within a facility or outside a facility, malpractice...
For instance, if the building is in New Orleans, then there’s a multiplier of like 1.1, where the rest of the state is 0.9. They then take the work RVU, add the facility RVU, and the liability RVU to get the RVU total, then do the multiplier.
Every other insurance company bases their reimbursement on Medicare. Many will be a percentage above, others like Medicaid and Tricare are a percentage lower.
Pricing is made by the hospital/clinic/provider, etc. to cover the cost of equipment, overhead (nurses and other staff, as well as utilities, malpractice), space, and so on. But ultimately it is based on the set rates by the government.
Going back to my gallbladder surgery example from earlier. BCBS pays $1400, United pays $1200, Medicare pays $1000, and Medicaid pays $800 (numbers are made up). I’ll charge $2000 to make sure I cover the upper end, but ultimately they’ll allow what the contract says the payment is. So for BCBS, they’ll/you’ll pay a total of $1400, and I eat the rest.
Now, the cost for the hospital will be different, it’s usually around $30,000 to go to sleep and have the OR for an hour. Then you add in anesthesia services. So in total, a gallbladder surgery, with 1 day of hospital stay will cost you and your insurance $40-50k.
And going back to the earlier post again, the actual surgeons percentage of your total cost is 3.5%. And yet we’re made out as the reason healthcare costs are so high.
Posted on 6/23/19 at 3:50 am to Mingo Was His NameO
Two problems I have with your answer.
1. I get that the equipment they use is expensive. But that is an asset that belongs to them, and not a direct overhead cost. It shouldn’t factor into the exorbitant price tag placed on a lot of procedures. I get that they have to get paid for, but let’s not pretend that doctors are barely scraping by. They are millionaires making hundreds of thousands (if not millions) per year.
2. I also get that there is an expertise involved that you pay for. But again, we’re talking major inflation in the price tag on that expertise. More than major. More like ridiculous. It’s almost sinful how much they charge. And keep in mind what we pay for is just a fraction, and insurance is paying a lot more than what we pay. So doctors are making a shitload for each patient.
I don’t expect doctors to do what they do and be living middle class and living check to check, but somewhere in between where they are now and that is what I would expect.
That plays into how fricked up our healthcare system is and is why people aren’t in a hurry to run to the doctor to be healthy. Because the doctor is throwing out this way over the top price on what you pay, and then use the excuse, “well, it’s your life at stake!”
1. I get that the equipment they use is expensive. But that is an asset that belongs to them, and not a direct overhead cost. It shouldn’t factor into the exorbitant price tag placed on a lot of procedures. I get that they have to get paid for, but let’s not pretend that doctors are barely scraping by. They are millionaires making hundreds of thousands (if not millions) per year.
2. I also get that there is an expertise involved that you pay for. But again, we’re talking major inflation in the price tag on that expertise. More than major. More like ridiculous. It’s almost sinful how much they charge. And keep in mind what we pay for is just a fraction, and insurance is paying a lot more than what we pay. So doctors are making a shitload for each patient.
I don’t expect doctors to do what they do and be living middle class and living check to check, but somewhere in between where they are now and that is what I would expect.
That plays into how fricked up our healthcare system is and is why people aren’t in a hurry to run to the doctor to be healthy. Because the doctor is throwing out this way over the top price on what you pay, and then use the excuse, “well, it’s your life at stake!”
Posted on 6/23/19 at 3:56 am to pngtiger
So it sounds to me like the hospital and then the government is running the show with healthcare. Which only confirms what I have always thought - that the whole system is based on crooks and greed. It’s why this thread topic is so relevant and a good topic.
Posted on 6/23/19 at 7:17 am to Cosmo
quote:
I love drug reps buying me steaks Then I never prescribe their stuff because generics are often just as good and cheap AF
You let drug reps buy you steaks? Seems like a pain to accept steaks since you have to report it under the Affordable Care Act if it’s more than $10. Not worth the effort to have to report and not worth the risk if you get caught failing to report it.
Posted on 6/23/19 at 7:38 am to SECdragonmaster
quote:
I am a private practice Physician
Dr. Dragon Master, I don’t get to ask medical doctors questions often but why are 75% of you medical doctors so vehemently opposed to voluntarily euthanasia for the physically healthy? And please don’t give me the “do no harm” part of the oath y’all take. Or any other MD reading this please give me an answer?
Posted on 6/23/19 at 7:44 am to OweO
quote:
Or how many doctors get kickbacks for using a certain company's product, etc?
A friend is in the junket food delivery business and his biggest customers are government and doctors offices. Big drug companies will feed the entire offices and folks know this so the "staff" doubles or triples the day the drug companies are picking up the check.
Posted on 6/23/19 at 7:59 am to The Torch
quote:
Once Obama let the cat out of the bag it all went to shite, premiums up 300-400% as well as deductibles
This was happening before Obama and ACA. It's one reason why ACA was written and passed. We had a similar conversation with UHC a year before Obama took office when our group premiums doubled.
And other than the first year or two after ACA was passed, premiums have mostly stabilized across the country, especially in states that expanded Medicaid.
None of that is to say ACA was a great thing. It wasn't all great and certainly had some glaring problems.
Posted on 6/23/19 at 8:02 am to RealityTiger
I’m not a Doctor, Reality Tiger but I can easily tell you how out of touch and what an idiot you are. How do you think assets for hospitals are bought? By charging you to use them. Doctors make hundreds of K because they should. It’s tons of work and most don’t start earning until their 30s. Add on to that the cost of med school, malpractice insurance etc. Most doctors have a staff that needs to be paid even if the doc takes a vacation. If they are not seeing patients, there is no $ being made. Have you been in the hospital and seen how many people come tend to you? Each hospital room can easily be $100k to build. Yes there is some fat in the system but not as much as you think.
Posted on 6/23/19 at 8:03 am to The Spleen
The thing people forget about the ACA is who wrote it. So, who wrote it? Insurance companies. Who do you think they wrote it to benefit?
The ACA in itself wasnt such a terrible idea. Letting the fox guard the chicken coop was.
The ACA in itself wasnt such a terrible idea. Letting the fox guard the chicken coop was.
Posted on 6/23/19 at 8:28 am to pngtiger
That’s all correct. And hospitals bill 3-5 times what they pay for products to ensure they get paid bc of their payer mix. It’s why places like sx centers can usually do procedures cheaper bc everyone they deal with had insurance. They don’t have to worry about the no pays in the ER, ICU, etc. eating up profits.
I’ve seen bills for multi level spine fusions and it’s crazy what the hospital bills the insurance comp.
I’ve seen bills for multi level spine fusions and it’s crazy what the hospital bills the insurance comp.
Posted on 6/23/19 at 8:32 am to OweO
OweO, if your aren’t happy with the current Healthcare system in the U frickin’ S of A, march your sorry arse over to the U.K. and go enjoy the NHS for a year or two.
To make omlets, you gotta crack some eggs.
PS: This message brought to you by the American Medical Association.
To make omlets, you gotta crack some eggs.
PS: This message brought to you by the American Medical Association.
Posted on 6/23/19 at 8:34 am to tke_swamprat
quote:
I’ve seen bills for multi level spine fusions and it’s crazy what the hospital bills the insurance comp.
What amount do they bill the insurance companies for a multi level spine fusion? Or at least what price range?
Posted on 6/23/19 at 8:38 am to Mingo Was His NameO
quote:
No it doesn't, and when it does people get caught and end up in jail and losing their medical license. The law and codes of ethics are quite clear on this.
It does happen. You and the rest of the medical professionals in this thread can act like a “code of ethics” and the law stops them from doing it but the fact is it does happen. Just like there are cops that lie, there are Drs taking kickbacks.
I’m not saying it’s rampant in either case but there are Drs doing shady things with pharmaceuticals just like there are lawyers, police, judges, etc that lie cheat and steal.
No one profession is immune.
Posted on 6/23/19 at 8:46 am to Mingo Was His NameO
quote:. Really? I have friend who got a bill one time for a EKG that he wasn’t told about and was never performed. This was 6 months after it was supposedly performed. When he questioned and and told them he never had one done on him they told him oh well the Dr. ordered one for you. When can do it right now today. He told them no and that he wasn’t paying for it. My point is supposedly they ordered one and billed him but never told him or did any kind of follow up. This was nothing than a money grab.
Not common at all
Posted on 6/23/19 at 8:55 am to OweO
It depends on company. Screws, inter body, stem cell, open vs minimal invasive and number of levels all make a difference. Seen some in the 80k, some north of 110k. Wide range.
Posted on 6/23/19 at 8:56 am to OweO
Thanks Obama
Posted on 6/23/19 at 9:07 am to OweO
(no message)
This post was edited on 6/14/20 at 11:20 pm
Posted on 6/23/19 at 9:10 am to OweO
quote:
What amount do they bill the insurance companies for a multi level spine fusion? Or at least what price range?
I didn't have a fusion, but I had two discs replaced in my neck.
Bill was just over 98k.
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