Posts
290
Joined
2/20/2011
Location
TN
US
Edited Date/Time
1/26/2012 10:43pm
My mom went in for knee replacement on her left knee. We took her in on a Tuesday, she got out of the hospital late morning on the next Thursday (in hospital for two days). She just got a breakdown of the hospital only bill (not including the rehab facility she went to or the ortho surgeon's fees) - if you would have asked me how much, I would have guessed around $20k - $25k. Turns out two days in the hospital and the knee replacement was $53,300!!!! I was completely speechless. Keep in mind that does NOT include the ortho surgeon's fees!!!! The new knee alone (two pieces of metal, one piece of plastic) was $24,000!!!! $53k?? How is that fucking possible????
I remember someone once telling me that non-profits don't make any money, but whoever owns the non-profit makes a fortune. She was in a very large (for our city) non-profit hospital.
Due to my good fortune, I've never been sick or hospitalized. Now I see how medical bills bankrupt people. It is absolutely rediculous.
I remember someone once telling me that non-profits don't make any money, but whoever owns the non-profit makes a fortune. She was in a very large (for our city) non-profit hospital.
Due to my good fortune, I've never been sick or hospitalized. Now I see how medical bills bankrupt people. It is absolutely rediculous.
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$53,000 seems really absurd.
Then they started paying for ancillary professionals too. That's why you never see the doctor any more for a checkup. Just the nurse-practitioner or physician's assistant. They get reimbursed more for those because Medicare thought it would save money. But instead the doctor can have a couple of n-p's and stack the office full of people he doesn't see, but get paid more.
In short, the $400 bill for an office visit for a checkup including labs is so that they can get the actual $75 for the visit and $25 for the labs that it really costs from the insurance company or Medicare. Or the $50,000 hospital bill is so they can get the $10,000 or $15,000 they will end up being reimbursed.
No way we could have come up with that and if she didn't get the knee replaced she wouldn't be walking or working now.
America spends so much on health care that if we found a way to suddenly start paying on par with the average country, our GDP would decrease so much it would look like we went into a depression.
Why people think the solution to this is to further privatize it is beyond me. It's private enterprise that has created the situation we have now. 15 years or so ago, private enterprise pushed these all-encompassing, you-pay-nothing-for-anything health care plans that disconnected the consumer from the price of services, and anytime consumers don't have any reason to ever consider the cost of services, the costs are going to increase exponentially.
You want to fix Medicare? Then (1) establish a policy that Medicare is going to pay health care providers the average cost of a procedure in other countries, and (2) require health care providers to do the services for that fee. Simple.
It becomes a huge difference for people without insurance, or people from the UK or Canada who are on long waiting lists.
US people are getting ripped of and being absolutely forced into having insurance.
Pit Row
No one will ever admit it in hospital administration, government, or insurance but socialized medicine has been here long before O. It is just being paid for by the people with insurance.
My patients from my last shift.
REAL Example 1 - Man is advised by his friend, cardiologist, to come to my unit to rule out MI for chest pain. Stays 24 hours, has several blood tests, basic mi med.s (morphine, asa, beta-blockers) and ekg.s. No heart attack. Upon leaving he is given the choice by $$ people to either file on insurance for $12k or pay $1800 on cash, check or cc. He was a small business owner who has a $10k deduct. He happily paid the $1800.
Real Example 2- Homeless woman comes in with Old Fart's afib. Stays for a total of 8 days because she is noncompliant with EVERYTHING for most of her stay. Should have been gone in 24-36 hours. Even though she is noncompliant, we could not discharge her because if she died in a few days the hospital and MD could be sued for millions by family. So the hospital eats pretty much everything unless a charity is found to help or will get pennies on the dollar of actual cost from Fed. indigent care programs. Plus we have to find her a shelter to accept her because we can't legally just put her on the street and foot the bill for transport.
Real Example 3 - 58 y/o exec. (code for good insurance) man comes in with massive infarct, 2 days icu, 4 bypass surg, 5 days my unit, physical therapy, cardiac rehab, tons of med.s and tests. 7 day total almost $300k. By the time it's all done, the hospital might see $200-$225 before the insurance companies finish negotiating.
Real Example 4 - 43 y/o, obese, uncontrolled diabetes, admitted with chest pain. Unemployed, no insurance. Odd, that the pt reports an allergy to morphine (gold standard for pain relief and vasodilatation of caridac vessels) so he gets dilaudid (damn near heroin in make up) and his first round of cardiac enzymes are negative for EKG changes. Since he still reports chest pain he is kept because the hospital and MDs can be sued for millions if he actually has a problem.
So another set of 24 hour tests are ordered along with g.i., and pulmonary test. Again, they are are negative. The cardiologist changes his pain med. to a tramadol (almost no "high" compared to diluadid) and tells the patient she wants to preform a cardiac cath. procedure for a final and definitive way to rule out cardiac disease. Again, she does not want to do this because he will not see a dollar out of it. But she could be sued for millions if she does not preform every test available and the patient could.
When I tell him I can no longer give him dilaudid and he will be getting tramadol, he comes unglued, takes a swing at me and demands his "Against Medical Advice" paper work so he can get the "fuck out of this shit hole." Funny as we were getting along great and he stated that this was the best hospital he had ever been in while he was getting his heroin. People who are having heart attacks generally are unable to jump up take a swing at a nurse and scream at the top of their lungs. The hospital and specialist will probably see pennies on the dollar of cost at best.
Now tell me who paid for my hospitals huge bottom line profit of 0.6% last month?
Those of us that pay insurance are paying the bills already.
These issues aren't as simple as red vs. blue, private vs. government. But you guys just keep stroking your egos by arguing such. I guess that I am infinitely stupid however.
Better yet, go open a hospital since they are such cash cows.
And why is this? Fed. is now monitoring "satisfaction surveys." Fall below the standard, less fed reimbursement. The big push is to bend over to kiss ass as if the pt.s are at the Ritz in hospitals across the country.
I treat all my patients with respect and dignity. But I'm there to save their ass, not kiss it.
I've been saying that for years. My company pays $1500/month for my family's health care insurance - and every dollar they spend on my insurance is a dollar they aren't going to pay me in salary (I'm not complaining about that, it's just a fact). My wife worked in health care about 20 years ago and keeps up with these things, and even the best, highest credentialed cardiologists and specialists are ready to just hang it up - they're so sick of having to conform to insurance company mandated protocols and standardized procedures, regardless of what they think their patients need, that they often tell their kids, "Whatever you do in life, don't become a doctor."
Again, when you disconnect customers (patients) from the costs of their care, and you disconnect doctors from the fees being charged (by making them effective employees instead of being business owners), and insurance companies have deep pockets to pay for everything because they all charge the same fees and companies have to pay them, then what you've created is a system that really CAN charge 2 1/2 times as much for the same service as the rest of the world does.
Actually, I wouldn't be as incensed about Paul Ryan's idiotic Medicare voucher system if it didn't force seniors into the same lunatic insurance system that broke the bank in the first place. If you want to fix health care, get rid of comprehensive insurance and make patients pay a percentage of their care. Do that for a decade or two and health care costs will come down to a reasonable level, and THEN maybe seniors with vouchers might make at least a smidgen of sense. Otherwise, it's insanity.
The "internal medicine hospitalist" MD will become an import job only (heading that way already) or the future will dictate more care by NPs and PAs. Those people work their asses off for 150-200k and walk around with a lawsuit bulls-eye on their back everyday. When reimbursement rates go down even more, expect pt outcomes to go down as well. The doc.s are sped too thin already.
As you probably know, most hospital MDs these days are contracted hospital employees paid by companies that vie for various departmental contracts. Yes, there are MD groups that do the same of course. My cousin is a Regional VP for such a company that provides speciality care. I won't say which for obvious reasons. I was shocked at what they paid their MDs. A basic specialists, depending on experience makes between $130K-$195k. Keep in mind these people work five-seven days a week with 24 hour per day availability. The top tier in this speciality were of course the surgeons that were priced between $400k-$600k.
My best friend, last year made $180k as an estimator / project manager. This in the midst of the worst construction recession since what the 70s? His bread and butter is PUBLIC landfill construction and yes he is very good at what he does. He barely graduated with a BS, doesn't have to worry about midnight emergencies, and has no personal multi-million dollar liabilities. He is doing better than the average MD in internal med, off of public money. And yet, people here want to bitch about MD wages. I mean how much did JS7 or 22 make last month? How about Blah Mahr or Glen the overly dramatic Douchebag Beck?
I also have two friends that work in Med. device sales. One is content in an old comfy position and makes just under 200 and the other is in the "NFL" and makes damn near $500k when he is nailing it.
I rarely would post in NON but have had a tough month caring for, rather being shit on and even swung at, by the poor downtrodden of this great country. The very people I feel the desire to serve. The people who are driving up yours and my health care costs. My bleeding heart is being clogged one shift at a time.
Perhaps some day we can hash this out over a couple of Sierra Nevada's, post ride of course. Trying to get my self in shape for the end of the Tony Miller's Night Series.
As far as the bills for knee surgery, I'm looking at the bill from the surgery center for having both knees scoped in 2010: $37,140, Discount $30,064, plan pays: $6,099, I paid $975.
So they billed $37k, and accepted $7k for the procedure. That's a fucked up system. I'm not pointing at one group on this, but, it's definitely a mess and as pointed out before, we, the consumer don't have any connection to the real cost of treatment.
In 2006 I had a hernia repair. Knew it was coming in Aug. 05 and planned for it in the next year so I could use flex spending account dollars. I called the hospital, the doctor, and the insurance company to get some idea of what the charges would be for this common procedure so I'd know how much money to put back since it's a use or lose it account. Nobody would tell me anything. So, I had to guess and I did ok, but, the reality is that if I had been over by $500 or $1000 and wasn't able to spend that money on other medical issues during the year, I'd have lost money using the flex spending account. That's a shit system. Just another broken element.
I remember DrMark saying he thought catastrophic insurance with a medical savings account was the way to go. Medical savings accounts roll over each year--not use it or lose it. I think that's probably a much better system than we have today.
In my experience professionally and personally, the whole world is filled with third parties that don't offer jack shit for value yet they collect the cream off the top and are now well into the meat of the economic pie. Medical insurance companies are just one example. Real estate agents are another fine example of middle persons that offer little value IMO. There are countless others.
Sorry to hear about the injuries, hope you heal up soon.
Just curious, what kind of doctor are you and where? I'm up in the Denton area, that's why I'm curious.
BTW, thanks for offering up your experience. I've heard similar stories from my sister in Phoenix and my brother who's at UT Southwestern. It's really crazy how expensive everything is but for sure, the hospitals are usually not the ones raking in the money, and those examples are perfect to show how just the threat of a lawsuit can double or triple the cost or a patient's total bill.
I have no insurance so I pay cash. The total was $3000.00.
I did the same thing when I had cancer. I shopped. I'll just give you one example. I needed a CT with contrast. Memorial Hospital wanted $1200.00. Another place wanted $900.00. I got it for $250.00. The place I went to does all the imaging for Memorial Hospital.
The reason our health care system is so expensive is because there is no incentive for people to shop.
That is unless you have to pay out of your pocket.
I understand your point. I don't know crap about the engineering side. But prior to my nursing career, I worked with him at Basketball Player Construction (excavation, paving, utilities, walls) in Frisco. I'm sure you can decipher. We were college buddies going back to '94, he got me my job there, and I believe I know him better than his wife.
He was and is a top producer and yes was and is considered a top level manager. Basically he will bring in 4-5 big jobs and then manage the operations to the penny. If he would have been part of the "club" there, he would have been knocking down $200k. His Operations VP basically answered to him, not vice versa. The VP new who made his numbers.
He was knocking down $125k there when I went out on my own in '06 and to go back to school, I saw the stubs. I, as their environmental guy was knocking down $85k when I left, had a four door xlt f150- 4x4, and a credit card to chase new business with. I basically produced enough to pay my salary and keep them out of hot water with the EPA/TCEQ. I still make good money on the side doing the permitting/compliance stuff, that is considering the time invested.
All the big boys went after him (TJ Lambrect, Sinacola, etc.) when Basketball Player Constuction shut down. TJ and Sinacola, from what I hear, aren't scared to pay $120-$150 for a producer. He got in with a small up and coming company with a $120k base and yearly bonus of 10% of bottom line profit off of his jobs. He brought in almost 7 million last year that put $600k to the bottom of the P&L. They are currently begging him to sign partnership papers and up his bonus %, because they are terrified he will go out on his own. Which is what I tried to talk him into anyway before going to small up and coming construction co.
Now, the regular guy estimators working the residential / road / utilities side of things that I still know, were and are making that kind of money. That is the ones lucky enough to have jobs right now. I know a lot of good guys sitting at home starring at the wall. What I understand most dirt/utility/paving contractors are doing those jobs for cost just to keep the wheels turning. And Weir Bros., is supposedly killing those numbers just to get the trucking $$$.
I know my main customer put 3% on a $6 million road job last Nov. and finished 7 out of 26, 1/2 mil back. It's brutal out there right now. There were companies from all over the US chasing that one. You wouldn't see that in '99-'08.
I was lucky in that I got out at the right time and had enough business to get myself thru school for the second time. Got out for 2 reasons: one on my death bed I wanted to know I did something a little more substantial than get rich guys their permits and keep them out of court (a little drama queenish I know), two I feared I would be out of work when it was time to start my family.
Now back to your other points. Those all sound typical of what I see and despite of my earlier rants I don't think the healthcare industry is anywhere in the ball park of perfect. It is broken to an extent and I don't know the answer. I was just illustrating what I currently see. That IMHO we are already in a socialized system were people such as Stamford's mom and those of us who pay insurance are already funding the healthcare system for the rest. Again just MHO.
Shit I gotta get in bed, gonna be up at 0530.
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