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The PPACA Thread Part III - Let's have a healthy debate!

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  • #61
    Re: The PPACA Thread Part III - Let's have a healthy debate!

    Originally posted by FlagDUDE08 View Post
    For some, this is the case, especially if they receive a government subsidy, and try to use it up in order to make sure they get the same amount in the next year. However, many of the tests are not necessarily relevant, but used as protection against a lawsuit. For example, when a woman goes in, they'll almost immediately give her a pregnancy test.
    Just a small example and may not be typical. 40 years ago if a patient presented to me with headaches, there was an office visit (about $15) at which time i spent time taking a detailed history asking pertinent questions for the patient to give me a complete description of how it presented, what it felt like, when it occurred, who else in the family had them, etc. and did a complete head and neck physical exam. if i found nothing to indicate anything more severe, they got some pain medication(probable cost for some low dose codeine $5) and some instructions as to what to watch out for and were sent home and asked to call me the next day. Then and only then, if they have not responded, perhaps a reexamination was done or some further testing ordered.
    In today's medical world, same patient, gets seen for an office visit of $150 but fills out a questionnaire instead of talking with the doctor for any length of time, a cursory physical exam(but is weighed and measured and other vital signs taken to insure payment as a higher level visit by the insurer or medicare). They are sent for a CT Scan and perhaps almost assuredly an MRI and maybe even to an ENT man for sinus films. Other tests may be ordered including a general series of blood screenings(cannot even overlook those obscure remote possible related problems). They are given an Rx for some non steroidal antiinflammatory(which most likely will not work as well as the codeine would have but certainly costs far more and upsets their GI tract more). With all the controls now in place and the fear that any opioid will lead to some kid somewhere taking it, selling it or OD'ing on it. After all this exhausting testing the patient has had the million dollar work up. The doctor feels a bit better protected that he did not miss something serious(which his medical acumen should have told him anyway) but is really no less safer from legal action since anyone can sue for anything. Perhaps the patient was talked to abruptly by the young lady at the front desk, or felt they were kept waiting too long, or found out some other test could have been done(maybe not even SHOULD have been done, just COULD have been done). Total cost beyond calculation. And most often, no clear diagnosis is made so the patient goes off to see someone else who repeats everything again and adds a few more tests because they always have to find something. Welcome to the world of medicine in 2015.
    Of course much of this is being facetious and i don't really believe that all testing is not of some value, but this happens all too often.
    Take the shortest distance to the puck and arrive in ill humor

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    • #62
      Re: The PPACA Thread Part III - Let's have a healthy debate!

      Originally posted by unofun View Post
      Some [doctors] clearly do [order unnecessary tests], just as some lawyers do extra work just to pad their fees, mechanics push for unnecessary repairs to pad their fees, etc.
      Generally, the doctors do not perform those tests themselves these days. My doctor orders an x-ray, I go to a radiologist; she does not perform it and has no financial interest in the radiology practice. She orders a blood test, I go to Qwest Diagnostics, etc.

      So if doctors are ordering "unnecessary tests" in these situations, how does that pad their bottom line (absent kickbacks)?

      There is plenty of health care fraud going on, but that is criminal behavior, not at all anything like what you tried to describe.
      "Hope is a good thing; maybe the best of things."

      "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

      "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

      "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

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      • #63
        Re: The PPACA Thread Part III - Let's have a healthy debate!

        Originally posted by FreshFish View Post
        Generally, the doctors do not perform those tests themselves these days. My doctor orders an x-ray, I go to a radiologist; she does not perform it and has no financial interest in the radiology practice. She orders a blood test, I go to Qwest Diagnostics, etc.

        So if doctors are ordering "unnecessary tests" in these situations, how does that pad their bottom line (absent kickbacks)?

        There is plenty of health care fraud going on, but that is criminal behavior, not at all anything like what you tried to describe.
        Only with small practices would third party subsidiaries be involved, such as the blood test company you mentioned. With the consolidation into large hospitals (which are conveniently shaped like prisons, mind you), you go to a radiologist or blood technician within the establishment, thereby not padding the bottom line of the physician, who is placed on a salary instead of a self-employment paradigm, but padding the bottom line of the hospital administration. Salaried doctors could then be coerced into ordering said "unnecessary tests" or face being fir- er, wait, in today's PC world, "termination".

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        • #64
          Re: The PPACA Thread Part III - Let's have a healthy debate!

          Originally posted by FlagDUDE08 View Post
          Only with small practices would third party subsidiaries be involved, such as the blood test company you mentioned. With the consolidation into large hospitals (which are conveniently shaped like prisons, mind you), you go to a radiologist or blood technician within the establishment, thereby not padding the bottom line of the physician, who is placed on a salary instead of a self-employment paradigm, but padding the bottom line of the hospital administration. Salaried doctors could then be coerced into ordering said "unnecessary tests" or face being fir- er, wait, in today's PC world, "termination".
          As you are not a doctor yourself, source please?
          Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

          Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

          "I've never seen so much reason and bullsh*t contained in ONE MAN."

          Comment


          • #65
            Re: The PPACA Thread Part III - Let's have a healthy debate!

            Originally posted by FreshFish View Post
            Generally, the doctors do not perform those tests themselves these days. My doctor orders an x-ray, I go to a radiologist; she does not perform it and has no financial interest in the radiology practice. She orders a blood test, I go to Qwest Diagnostics, etc.

            So if doctors are ordering "unnecessary tests" in these situations, how does that pad their bottom line (absent kickbacks)?

            There is plenty of health care fraud going on, but that is criminal behavior, not at all anything like what you tried to describe.
            The closest way to a doctor milking the testing process, in the small practice situation you described, is the followup consultation visit. In my experience, it's a separate set of fees charged between the initial visit and the followup visit.
            "The party told you to reject the evidence of your eyes and ears. It was their final, most essential command." George Orwell, 1984

            "One does not simply walk into Mordor. Its Black Gates are guarded by more than just Orcs. There is evil there that does not sleep, and the Great Eye is ever watchful. It is a barren wasteland, riddled with fire and ash and dust, the very air you breathe is a poisonous fume." Boromir

            "Good news! We have a delivery." Professor Farnsworth

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            • #66
              Originally posted by FreshFish View Post
              Generally, the doctors do not perform those tests themselves these days. My doctor orders an x-ray, I go to a radiologist; she does not perform it and has no financial interest in the radiology practice. She orders a blood test, I go to Qwest Diagnostics, etc.

              So if doctors are ordering "unnecessary tests" in these situations, how does that pad their bottom line (absent kickbacks)?

              There is plenty of health care fraud going on, but that is criminal behavior, not at all anything like what you tried to describe.
              Hence my use of some, not most or all.

              My doctor's office is part of a system of medical offices through out the Des Moines area. If they refer me to get an xray next door, it still feeds the system's bottom line and their salaries (or partner shares - for all I know it's organized like the standard law firm would be).

              Comment


              • #67
                Re: The PPACA Thread Part III - Let's have a healthy debate!

                Originally posted by Rover View Post
                As you are not a doctor yourself, source please?
                It's called taking FlagDUDETTE to a hospital at her request, dingbat.

                Comment


                • #68
                  Re: The PPACA Thread Part III - Let's have a healthy debate!

                  Originally posted by FlagDUDE08 View Post
                  It's called taking FlagDUDETTE to a hospital at her request, dingbat.

                  Anybody in a relationship with you would obviously be in need of medical attention! But again, this is anecdotal, not a overall trend. As we've asked repeatedly, show us where doctors are quitting the practice wholesale.
                  Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

                  Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

                  "I've never seen so much reason and bullsh*t contained in ONE MAN."

                  Comment


                  • #69
                    Re: The PPACA Thread Part III - Let's have a healthy debate!

                    Originally posted by FlagDUDE08 View Post
                    With the consolidation into large hospitals (which are conveniently shaped like prisons, mind you)
                    I don't know what you're taking, but you either need to lay off it completely or take a lot more.

                    Comment


                    • #70
                      Re: The PPACA Thread Part III - Let's have a healthy debate!

                      Originally posted by Priceless View Post
                      I don't know what you're taking, but you either need to lay off it completely or take a lot more.
                      I don't know, we've had a few cities build their high schools to look like shopping malls so that they can be converted someday. This could be a thing.


                      (Yeah, okay, while the high school bit is true I'm thinking that the hospital thing is just a man in need of his meds.)
                      "The party told you to reject the evidence of your eyes and ears. It was their final, most essential command." George Orwell, 1984

                      "One does not simply walk into Mordor. Its Black Gates are guarded by more than just Orcs. There is evil there that does not sleep, and the Great Eye is ever watchful. It is a barren wasteland, riddled with fire and ash and dust, the very air you breathe is a poisonous fume." Boromir

                      "Good news! We have a delivery." Professor Farnsworth

                      Comment


                      • #71
                        Re: The PPACA Thread Part III - Let's have a healthy debate!

                        Originally posted by Priceless View Post
                        I don't know what you're taking, but you either need to lay off it completely or take a lot more.
                        There isn't enough Seroquel in the world to quell Flaggy's paranoia.

                        Originally posted by St. Clown View Post
                        I don't know, we've had a few cities build their high schools to look like shopping malls so that they can be converted someday. This could be a thing.
                        When Chrysler built their 'new' HQ 25 years ago, it was also designed and constructed with this in mind.

                        Comment


                        • #72
                          Re: The PPACA Thread Part III - Let's have a healthy debate!

                          Originally posted by St. Clown View Post
                          I don't know, we've had a few cities build their high schools to look like shopping malls so that they can be converted someday. This could be a thing.
                          More than you know! Due to online retail, many shopping malls are closing due to reduced store traffic, and they are being converted to server farms.

                          I kid you not. Quite poetic in a way.
                          "Hope is a good thing; maybe the best of things."

                          "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

                          "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

                          "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

                          Comment


                          • #73
                            Re: The PPACA Thread Part III - Let's have a healthy debate!

                            Originally posted by St. Clown View Post
                            The closest way to a doctor milking the testing process, in the small practice situation you described, is the followup consultation visit. In my experience, it's a separate set of fees charged between the initial visit and the followup visit.
                            Good point. Explains why my old doctor was okay with a physical every other year, and the new one wants to see me every six months. Though I'd much rather be able to consult with her online and find a way to pay her for that time, the current reimbursement procedure is a bit antediluvian in that regard. one of the biggest problems with PPACA is that it freezes technology into a static model and stifles innovation because of the centralized command-and-control structure. If the half-dozen people in charge don't think of it, it won't happen, compared to having thousands of creative entrepreneurs continually tweaking things.
                            "Hope is a good thing; maybe the best of things."

                            "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

                            "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

                            "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

                            Comment


                            • #74
                              Re: The PPACA Thread Part III - Let's have a healthy debate!

                              Originally posted by FreshFish View Post
                              one of the biggest problems with PPACA is that it freezes technology into a static model and stifles innovation because of the centralized command-and-control structure.
                              Examples, please.
                              Legally drunk???? If its "legal", what's the ------- problem?!? - George Carlin

                              Ever notice how everybody who drives slower than you is an idiot, and everybody who drives faster is a maniac? - George Carlin

                              "I've never seen so much reason and bullsh*t contained in ONE MAN."

                              Comment


                              • #75
                                Re: The PPACA Thread Part III - Let's have a healthy debate!

                                Originally posted by Rover View Post
                                Examples, please.
                                It's called a monopoly on ideas. Not sure if you work in any sort of creative outlet or not (I'm in SW development), but if you do, ever notice how ideas you would like to see implemented have to go up a chain of command? Basically the same thing with medical technology. With free range care, where there's no large hierarchial structure and simply a bunch of small entities with a small structure, you can try just about anything you want. Once you start adding that bureaucracy (whether government, commercial, or industrial), you have to go through so many hoops just to try something out. Not to mention, all the other things that are needed, such as FDA approvals (a buck says I get some wise guy turn-of-the-20th-century response about that), making sure it fits within the surprisingly tight confines of ACA "basic coverage" regulations...

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