Medical Malpractice

[metisnation]

Doctors and Nurses are not the problem, the hospital structure is the problem. I had a surgery and they charged me 33 bucks for a 3 dollar piss pan. Doctors are just the workers, hospital administrators are really to blame when it comes to the cost of high health care costs. Talking about corporate welfare to the max. When have you seen a (private) hospital that is not remodeling? Like I need that waterfall in the waiting room...Democrats need to support the doctors and get one the asses of the overcharging huge beaurocratic empire that we all view as some harmless hospital.

[liberalhistorian]

1. I will support doctors when

they support US, the patients, and when they are on our side and not the side of the insurance companies and the pharmaceutical companies.

I will support them when they actually try to do something about the horrendous inequities in health care access and affordability and when they and their hospitals quit trying to aggressively and ruthlessly collect bills from uninsured/poor patients and try to take what little assets they have.

I will support doctors when they quit refusing to treat people if they're uninsured/have no money upfront.

I will support doctors when they get off of this ridiculous fixation on the non-existent, phoney-baloney so-called "malpractice crisis", and start helping to support and implement some type of national health care program guaranteeing access and affordability for all, regardless of income.

I will support doctors when they start seeing patients as people and not profits.

I will support doctors when they quit equating the importance of our lives with how much money we have and what our socioeconomic status is.

I will support doctors when they finally start remembering the Hippocratic oath they supposedly took, and when they regain their profession's principles.

[metisnation]

2. BS

thats what they want you to believe about all doctors. It is not true I know four doctors personally and they are all Democrats and work in public and private institutions. 2 of them are in Sri Lanka working for free right now helping the victims. Hospitals take you to the bank for all sorts of stuff that you probably had no experience with. Wait until unbundling health costs is standard and you get to see line per line what you have been charged for. There are some doctors that reflect your suggestions, but wholesale this is not fair.

[Deja Q]

65. Life isn't fair.

Life is what we make of it, so why isn't it the way we romanticize it to be?

[Warpy]

4. Most docs are good guys and they're right with you

Most of them know that a single payer plan is the only thing that will get the bean counters off their backs and allow them to prescribe appropriate care for their patients.

Most of them have had to take on twice as many patients to keep their income steady. In any other profession, that's called a speedup.

Most of them know that cost cutting on the backs of nurse and ancillary staff have left hospitals dangerously understaffed and their sickest patients at risk.

Most of them know that the only way to get out from under the paperwork avalanche is to streamline the whole business under a single payer system.

Most of them are sick to death of having to fight insruance companies on behalf of their patients who are being stonewalled by some nonmedical moron who is going by some dumb insurance company formula used to deny care.

Most docs realize that they and the patients aren't the problem with malpractice premiums, that the insurers havwen't been making money in the stock market and are generating their huge profits on the backs of doctors.

Most docs are good guys who are most interested in healing people. The ones who went into it for the money are generally headed toward some sort of administrative position, since those positions don't involve taking night call and coping with sick people.

[knitter4democracy]

9. Thank you!

I'm so sick of the doctor bashing going on here recently. My husband is a strong liberal who also happens to be an internist. You know what turned him into a liberal (after being a member of the Republican Party, no less)--med school.

I have yet to hear any doctor who loves or even supports the system. They all hate it. I have yet to hear any doctor not start raving on and on about how evil Pharma is or how they'd love to get rid of insurance companies today. Most doctors want a single-payer system of some kind but are gun-shy, having been burnt by Medicaid and Medicare.

My husband didn't get home until midnight last night and then go back in at six this morning for the money, I can tell you that. He did it for his patients.

[liberalhistorian]

10. I beg to differ with both of you.

My own doctor of over ten years only cares about the money now, and was furious when I refused to contact our legislators about the so-called "malpractice crisis" after he demanded that his patients do so. During periods of time when I've been uninsured, his office has refused to even consider seeing me unless I cough up $75 up front in cash. And 90% of the doctors I know are the same way, I know very few like your husband. I don't see them caring about the patients, I only see them caring about money, propping up the current system, and being in bed with insurance and pharmaceutical companies.

[knitter4democracy]

22. What the heck?!

That is insane! Wow. I'd be pissed too, if I were in your shoes. Hmm. Are there any new doctors in the area who've recently finished residency? They're usually a little more liberal and haven't gotten too jaded yet.

Of course, you could move to beautiful Southwest Michigan--cheaper living, beautiful surroundings, nice people, and one heck of a doctor! :)

[liberalhistorian]

45. I'd love to move

away from Ohio if I could just find a job there, lol! Kudos to your husband, btw, we desperately need more doctors like him. I know it has to be hard for him. And I'm well aware of the terribly grueling process that doctors have to go through to become doctors, and I also know that many doctors volunteer at or work in clinics serving economically disadvantaged areas (there just aren't nearly enough of them for the need).

And I'm not at all saying that they don't deserve to be compensated for their time, skills, efforts, and knowledge. I'm just incredibly frustrated with the current system and with the fact that far too many doctors seem to be on the side of hospital corporations, insurance companies and drug companies. Maybe it's just the area and state I'm living in, I don't know.

[knitter4democracy]

56. I'll help you find a job, if you want. It's a hobby of mine.

Ohio's doctors have really closed ranks after seeing some really good ones get squeezed out of business by premiums. It's too bad, really, as many are good and should be thinking more clearly about it.

Seriously, though, if you want to move up here, I'll see if I can find something for you. Cheaper living, good doctor, beautiful area--couldn't be better! We're trying to get doctors training in Cleveland to think of Battle Creek and Kalamazoo too for when they get out. It's not too far from Ohio, travel-wise, for families, but it's much cheaper.

[ChairOne]

12. I'll take your point-by-point rebuttal here, in public then....

.... if you don't mind...

http://www.citizen.org/documents/MedMalBriefingBook08-09-04.pdf

Specifically, tell me why jillions of preventable medical errors aren't important, and why doctors should have a permanent get-out-of-jail-free card (aka tort reform), rather than actually, um, I dunno, cutting down on the damn preventable medical errors (first and foremost, by policing themselves).

I'm fascinated to hear the rationale for all of this.

[ChairOne]

14. Gawddagnab it! I want a rebuttal! lol

A rebuttal to the idea that the malpractice insurance rates are the fault of those 100s of 1000s of people injured yearly by preventable medical errors.

Christ -- they didn't even dress sexy, and it's *still* their fault?

rofl

[knitter4democracy]

23. I don't understand your point; I'm sorry.

I have never heard any doctor condone malpractice or think that any doctor who harms a patient shouldn't have anything happen to him--and I know a lot of doctors. Most think, though, that if a doctor is really bad (has been sued many times and obviously sucks at his job) that he needs to get his license revoked permanently in addition to any lawsuit for damages.

Keep in mind, less than half of all doctors are members of the AMA--don't read their crap. My husband is only a member so he can wreak havoc from within. ;) They wouldn't even endorse one of their own, Dr. Dean. Shmucks.

There is a problem with malpractice, though, that makes many doctors squeamish. Doctors are human, but the legal system doesn't let them be (and neither does theirs, but they don't like to admit that). Humans make mistakes. Bad things happen, and sometimes, it's a doctor's fault. When a doctor's working 30 hours straight, he's going to make mistakes. Most won't result in any harm to the patient because they get caught, but some do. If the patient gets hurt, all heck breaks out in the hospital, usually. There are meetings with lawyers, specialists who show how it happened and how they can make sure it won't ever again, other doctors who rip into them at the next Mortality and Morbidity Conference, and then the doctor has to live with it afterwards. Malpractice often hurts both the doctor and the patient--and not just the doctor's wallet, either. It's hard to understand if you never try to see it from their perspective.

[ChairOne]

25. Read the report.... then tell me what you think......

"the legal system doesn't let them be "? lol - if they would police themselves, we wouldn't have to go to the legal system in the first #$%%#$^ place.

[knitter4democracy]

27. They do police themselves

I will read the report, but seeing as my husband lives with this everyday, actually took two health law classes in med school, and has actually seen medical malpractice (and then been the doctor to clean up the mess), I'm not sure it'll help.

Doctors do police themselves and, might I say, better than some other professions do. If a solo guy hurts a patient, other doctors usually have to clean up his mess and start not referring patients to him. The nurses start spreading the word that he's a bad doctor, and that's usually when he either retires early or moves. Since they're starting to get a national licensure program up and running, soon he won't even be able to move. If someone in a group hurts a patient, it's not unusual for the group to crack down on him (limiting his practice, forcing him to take unpaid leave for attorney's meetings, making him go through a Mortality and Morbidity report in front of everyone, etc.). If it happens in a hospital, there's an M&M conference, lawyer meetings, meeting of the whole dept. to see what happened and how to make sure it never happens again, etc. Granted, this all doesn't always happen--it depends on the case. If it was an honest, easy-to-make mistake, the doctor will have to live with it and ask himself all the time how he could've let it happen. If it was worse, he'll lose patients and could lose his license.

M&M conferences are usually pretty nasty: the doctor in question presents the whole case, not leaving anything out, to all the doctors who come (usually everyone), and then everyone starts firing a million questions at the guy, forcing him to see that he seriously screwed up and that he needs to change. Sometimes, they even take some privileges away (he can't admit from the ER, he can't have patients at that hospital for awhile, etc.), depending on what happened.

Keep in mind, the actual numbers of medical error are lower than originally reported. When independent researchers looked at the data, they found that an error, if it fell into more than one category, was counted for each category it fell in--could've been counted many times, even though it was one error. They said that the number was closer to half of what was reported, and a lot of those errors are systems errors (a nurse reads a note wrong and gives the wrong medicine or dosage by mistake, the pharmacy gives the wrong medicine, the doctor sees two patients in rooms right next to each other and switches items in their charts by mistake, stuff like that)--and usually (at least in the hospitals my husband's been in) if a systems error happens, all hell breaks loose.

[ChairOne]

31. Ooops - just saw your other post... nm...

[knitter4democracy]

32. See Post #29

I'm sorry you don't like anecdotes. If you want data, read AMNews, the New England Journal, and JAMA. They've been dealing with everything you're upset about for a couple of years now.

Apparently, you're more interested in your point of view than actually learning anything. That's too bad.

[ChairOne]

35. Nah. Just didn't see your other post in time..... /eom

[merh]

43. If a family member is killed or harmed due to the malpractice of

a physician, try to find another physician willing to testify to the fact that it was malpractice. Also, try to get the AMA or the state medical licensing board to investigate the incident and to sanction, suspend or revoke the license of the physician.

Physician, heal thyself. They have to begin the process of cleaing up their profession before they will get any sympathy from me. The police have the "thin blue line" and the members of the medical profession have the "thick white line."

My hat is off to your husband, but he is a member of a very small minority in his profession. I hope he does well and works to make changes in his profession.

[knitter4democracy]

53. He's trying!

Well, there are experts who testify all the time, but sometimes it isn't malpractice. If a doctor went against accepted guidelines and harmed a patient, that's malpractice. It's that there aren't guidelines for everything, and some lists differ from other lists.

You're right about the state boards, though. They definitely need to crack down harder. They can't do so without more funding, though, and the republicans in my state keep cutting the budget. Grr! Bad doctors hurt everyone!

[merh]

60. The experts are part of the outrageous costs incurred by the

plaintiffs that pursue malpractice cases. Most people look at a plaintiff's case and think that the attorney's fees are outrageous, when in fact, they are fair in comparison to the efforts that the attorneys have to put into the case. Most plaintiff's don't pay a lawyer anything to pursue the claim. The attorney pays the out of pocket expenses (expert fees, deposition costs, costs of medical records, costs to review medical records, travel costs, copy costs, court costs, etc.) and puts in the time to litigate the case without a dime from the plaintiffs. Since generally a plaintiff attorney's practice is contingency and not hourly, there is no money coming in during the time the attorney is representing the plaintiff. The defense attorneys (who are paid on an hourly basis by the insurance carriers and/or the hospitals - they get paid no matter what the outcome is) know this and they will stall the case, file multiple motions and pleadings in an effort to "break" the plaintiff's attorney and force the attorney to give up or take a quick settlement. Most "local" doctors that work with or have a personal/private relationship with the offending doctor or just work in the same community as the doctor will not even review the records or give an opinion about the case, let alone act as an expert. Those doctors that agree to be an expert or agree to being deposed charge exorbitant fees ($450 to $2000 an hour). Plaintiff attorneys only get paid and their out of pocket expenses reimbursed if they are successful.

Again, don't blame the lawyers, the "thick white line" is real and hard to cross, let alone break.

I pray your husband is successful in bringing about a change. Lord knows we need it.

[knitter4democracy]

62. They had a really good article on that in a recent issue of

Medical Economics--a great journal for doctors, btw. They had an MD/JD do an interview explaining how the costs all add up and how much the attorneys have to pay hoping to get something, anything for their client. While there were some negative lttes, there were some positive ones as well, a good sign, I think.

[merh]

66. That is a great sign. To have an article like that in a medical journal

gives me hope. Do you know how I can obtain a copy of that article? I would love to read it.

Thanks for the discourse. As I said, I pray your husband does well, we need people like him in the profession, ones that take their oath seriously and care about he patient first.

:toast: I toast him and thank you again.

[knitter4democracy]

68. I found something

Medical Economics has a whole issue devoted to this. Here's the link:
http://www.memag.com/memag/issue/issueDetail.jsp?id=5507

I hope that works. That's a different issue, though, and I can't seem to find the other one.

Whoops! Found it: http://www.memag.com/memag/issue/issueDetail.jsp?id=4413

They let you look at a good bit on-line. I forgot about the more recent one because David took it to work (we fight over the Med Econ journals--the best one to read yet other than Placebo Journal).

Thank you for the nice thought! I've been wondering if I'm just offending everyone . . .

[merh]

70. Gosh, no offense at all.

We have to get doctors and lawyers talking and respecting each other's professions. It is not he legal or medical professions that are the culprits, it is the corporate greed of the hospitals and the insurance companies.

I appreciate your willingness to know all sides.

A DU :grouphug: to you and your husband! And a belated welcome to DU! :hi:

Thank you for the links.

[knitter4democracy]

72. Thank you! nt

[liberalhistorian]

46. I understand it from the medical

perspective, and I do agree that people often won't let doctors be human and expect them to be perfect all the time. I also don't think that people realize just how hard it is for doctors and the stress that they're always under. A lot of that, though, is because most people don't know any doctors personally and therefore don't socialize or interact socially with them. The only time most people see doctors is when they or a family member/friend are sick, and that's usually a stressful situation where they're not thinking clearly anyway.

My own gynecologist really screwed up with me for the three years prior to my hysterectomy. I suspected I had endometriosis and kept asking for testing, and she just kept brushing me off because she didn't think it was endometriosis or anything else, she just kept prescribing stronger painkillers. When I finally experienced pain and bleeding every day of the month and not just during my period, she finally did some tests, discovered ovarian cysts and an abnormal pap smear, and decided to do a hysterectomy, which was just fine with me since I was 37, had one child, was single, and wasn't planning on any more kids. After she did the hysterectomy, she came into my room quite stricken and immediately began apologizing. She said that not only did I have endometriosis everywhere, but ovarian cysts, fibroids, and a fallopian tube had twisted and embedded itself into an ovary. She said it had obviously been developing for some time and she should have tested sooner so I wouldn't have had to go through all the years of pain and discomfort. I was angry at first, of course. But she was genuinely apologetic and remorseful, and I realized that the hysterectomy had taken care of the problem and that there was no point in continued anger and resentment. I told her, though, that from now on it would be good if she really listened to her patients and took their concerns seriously if they thought they had a particular condition based on their symptoms, and not just brush them off with painkillers. Next time, I said, it could be something a lot more serious that might not be taken care of just with surgery or that could cause permanent injury or death to someone. She agreed, and I really believe she meant it. She was nervous because she also knew I was a paralegal, but I reassured her that I was a paralegal for a business and real estate attorney and we had a good laugh.

But what about the patients who suffer serious and permanent disability or even death because of negligence or mistakes? Even if it was a mistake and the doctor is genuinely sorry, as I believe most of them are, that doesn't help the patient, especially if they're fairly young and they have a lifetime of medical care ahead of them if they can't work and/or support their families. Hundreds of thousands of dollars may seem like an awful lot of money, but it really isn't if it's a child who must be taken care of for a lifetime or a person with decades more ahead of them who can't work. While most mistakes are certainly not purposeful or due to negligence, that doesn't help these people.

[knitter4democracy]

54. I have endo too. I'm so sorry you went through that.

Wow. That Ob/Gyn was freakin' lucky you didn't have ovarian cancer, or that would've been a huge sanction and payout. It's good she admitted her mistake, though, because that should mean that she'll practice differently. My endo was caught after a month of hell and finally getting to a gifted Ob/Gyn who figured it out from my history alone. Something like eighty percent of all diagnoses come from history, and ten more percent come from a thorough physical. She just wasn't listening.

I agree that people should get the money they need to keep care of them and free health care too. My husband always says that if he hurts a patient, he would want the best for them, including money. People have a hard enough time these days.

[knitter4democracy]

29. Okay, I read it and my husband and I would agree with most of it

Section I: totally agree. The data shows that lawsuits are not the problem and are being used as a scapegoat by a corrupt insurance system. Lawsuits count for little of the costs, actually.

Section II: totally agree. My husband's been saying that for years.

Section III: don't entirely agree. Much of the "crisis" can be laid at the feet of the insurance companies. Yes, malpractice occurs, and something like 10% of the doctors are committing 90% of it (read that in AMNews, the weekly from the AMA). It's a serious problem, and doctors are talking about how to police each other better without hurting good doctors at the same time. That's more difficult than it sounds. The system's seriously broken, and there are many ideas on how to fix it, but not very many good ones.

Section IV: somewhat agree. The AMA blows that one out of proportion, as does the doctor rumor mill. If one or two guys leave, saying it was their costs, then it's a "crisis." I will say, however, that my OB/Gyn who helped me deliver my daughter is no longer practicing in Cleveland (went and became a flight surgeon) because they doubled his malpractice in one year to $100K (and the practice's to half a million). It's not like you break that into monthly payments--it's all due now. Where was he supposed to come up with that kind of cash? It is happening, but it is on a lower scale than it sounds in the media.

Section V: totally agree. All that is going to do is hurt patients. Most frivolous malpractice cases are settled or don't even make it to court. The real stuff is serious. The only cap I would like to see is the time limit for OB/Gyns--in many states, they can be sued up to 21 years after the fact and then get held up to today's standards. That's simply not realistic. They've changed everything in medicine a lot in twenty years, and many doctors practice entirely differently now. How would you like to get sued for something you did twenty years ago?

If you don't mind, I'll have my husband look at that when he has some time (might take awhile). I'm sure he'd be interested in that report.

[HuckleB]

36. Good post.

Of course, what is called malpractice isn't always malpractice, it's health care providers making the best decision they can based on the evidence available to them, but still making the wrong decision. Medicine is still very much an art form, as well as a science. Alas, this is ignored by too many health care providers themselves, not to mention patients and media and lawyers and and and....

Your point about OB/Gyns lawsuit time limits is very well taken. That's a huge issue, as knowledge and accepted practice change quickly. And complications at birth are too often dealt with under the reality of too little knowledge. Health can't know everything about every situation, at least not yet. This is what can lead to a situation where there are too many unnecessary C-sections, yet there are children born every day with serious complications that would have been prevented if a C-section was used. In most cases, the OB/Gyn made the best decision he or she could with the information available. Yet, doing so doesn't always hold up in court.

Medicine can be made safer, should be made safer, must be made safer. But the issue is largely systemic, and we can't forget that we do not know enough about the body, the brain, etc... to always create positive outcomes.

[knitter4democracy]

55. Thank you for understanding.

I'm just sick of people attacking all doctors here, even the good ones. It's easy to paint with a broad brush, but that doesn't make it right. The issue is more complicated than most know.

[liberalhistorian]

47. About Cleveland and

Ohio malpractive insurance rates-that's been a huge problem in this state, and a lot of doctors are claiming it's just because of malpractice suits and awards. That's been debunked quite often, though, but they still believe it.

And that's exactly what the insurance companies want them and the general public to believe. Because it's the INSURANCE COMPANIES that are causing the problem. Even after it was shown that Ohio's malpractice awards and lawsuits had gone down over the past several years, and even after torn reform was enacted, the malpractice rates still kept going up and up. The insurance companies have the discretion as to how much to charge, and they're taking advantage of that to soak doctors and other medical professionals. They seriously mismanaged themselves in the 90's, making bad decisions, etc., and now they're trying to make up for it by blaming non-existent lawsuits and awards instead of themselves and their own incompentence and mismanagement. And they've sold the doctors and hospitals on that.

I don't blame doctors for leaving with the horrendous malpractice insurance rates, but they need to put the blame where it belongs, with the insurance companies, and not with patients and lawyers.

And, if it's any consolation to doctors, as a paralegal, I can tell you that legal malpractice insurance rates have increased horrendously as well, courtesy of many of the same insurance companies that set the medical malpractice rates. Even if the attorney has a good record and has never been sued (and believe me, attorneys can be and are also sued for malpractice), their rates are going up and up, to the point where some solo attorneys are starting to struggle.

[knitter4democracy]

51. My husband went to med school in Cleveland

Most of his profs said it was the fault of the insurance companies. Most doctors I know hate insurance companies almost as much as they hate lawyers (but then always want the best when they need one--*sigh*). Part of the problem is where doctors get their info from--medical associations who often have ties with insurance companies.

[Nobody]

15. My doc knows I have no health insurance

and yet I have a chronic condition.

He gave me six months of pills I can't live without for free.

In most places, when I mention my lack of health care coverage and what I think of the Republicans not doing anything to help, I hear agreement from everyone from doctors to pharmacy techs.

[liberalhistorian]

20. Well, I'm very glad to hear that,

and especially glad to hear about your doctor (good for him!), but that just isn't the case in my area or in any other area I've been and interacted with doctors. Not at all, in fact, it's the exact opposite.

[pnb]

16. I work with doctors on a regular basis

And the things you are saying, except for the very occasional exception, are simply not true. Physicians do care foremost about the health of their patients. It does also happen to be their livelihood and they do have to deal with huge amounts of bureuacratic BS themselves...that's where companies like mine come in to help.

This falsehood is spread by many and is simply unfair. Physicians are also allowed to make a profit, especially considering the time and expense necessary to even become a doctor in the first place. No one has a right to get on their case because they actually attempt to get paid (and in this day and age, it is more often a billing company doing the collections anyway rather than the physicians themselves. Physicians are notoriously bad business people and tend to delegate much of the business aspects of health care to others and just concentrate on the clinical aspects of their jobs.)

[pnb]

17. Dupe

n/t

[liberalhistorian]

21. Yes, doctors have every right

to make a profit. And people with serious, chronic, or life-threatening illnesses have the right to quality treatment and the right to save their own lives without having their houses and everything else they own taken away from them to pay for it.

[eridani]

71. They are--

-- see http://www.pnhp.org/news/mccanne.pdf

This link is to a succinct (3 page) journal article making the case for single payer by PNHP Past President Dr. Don McCanne. It was just published in the world's first peer-reviewed, "open access" medical journal. McCanne is the author of the popular and influential health policy

[Cobalt Violet]

3. Insurance companies made record profits in 2004.

So I can't see why doctors aren't complaining about that instead of trying to have the rights of their patients to the courts stripped away.

Tort reform is about the People vs. Corportations. Medical Malpractice Insurance Rates aren't what it is all about. But many doctors think that's what it's about.

[metisnation]

5. Bill Frist

is a poor represenative of the industry. I think we view it through this filter it is that their organization hierarchy is supporting this but not the average doc. The people that make the cost go up are the beurocrats that ae squeezing the pateint and the doctor by allowing the added costs of multiple paper shuffling between HMO PPO's and doctors.

[knitter4democracy]

8. They are.

Read Placebo Journal. It'll show you how most doctors really think.

[blurp]

6. You're paying for hidden socialized medicine.

The difference is that, instead of paying for someone else's free care through taxes, they're collecting the extra money at the hospital.

[blurp]

7. Let me add that

If it's already hidden, why not just go the whole way and "unhide" it?

[Xithras]

18. Bingo, there's a reason why $3 piss pans cost $30 in a hospital

Without any kind of national health insurance, most people visit the ER when they have a medical problem, and a HUGE number of people skip out on the bill leaving the hospital holding the bag. In order to stay open, the hospital has to make up for these losses by passing the costs on to the paying patients through increased prices for goods and services.

A national health insurance program to eliminate no-pays should substantially reduce many of the astronomical costs that we pay.

By the way, I don't support socialized medicine. I'd like to see some sort of national insurance program coupled with our current medical system, with the insurance rates indexed to the recipients income. The more you can afford, the more you pay.

[liberalhistorian]

19. Excuse me, but a "huge number

of people" DO NOT just "skip out on their bills!" Most people who are uninsured usually also have little money or assets to pay even their basic necessities, let alone a ridiculously huge hospital bill. They often want to pay, and want to work out an arrangement, but the hospitals usually want all of their money NOW!

I know, because as a paralegal I've worked with a lot of these people in these types of cases and the hospitals are absolutely horrendous. Not only do they charge the uninsured up to 22% more than the insured for the same procedures, they're absolutely ruthlessly aggressive in collecting the bills, even if that means garnishing huge amounts from already meager wages or taking what little assets these people have. The Wall Street Journal, of all papers, did an expose last year on how hospitals are now one of the most ruthlessly aggressive collectors in the country, even using "body attachments" and throwing people in jail who can't pay and who can't afford the absurd payment "schedules", which eat up the majority of a person's take-home pay.

My own area hospital has sued me for money I didn't have and made it clear they were going to do everything in order to get the money, even go after my car and most of my wages. For a lousy six hundred bucks that I'd previously tried to make arrangements to pay since I didn't have it all at once. But they weren't interested. Had it not been for my former boss, an attorney, they could have really screwed me.

Consultants for hospitals have called the uninsured a "cash cow" for hospitals since they can charge them a lot more and they can then go after everything the person has to get it. And their charges are absolutely ridiculous even for the insured. I had pneumonia last year and ended up in the emergency room. I was there for four hours and they charged me FOUR THOUSAND DOLLARS which they then wanted immediately. Even my insurance company balked at all of their charges. So, please spare me the sob story and tears for hospitals. Boo-fucking-hoo.

[Princess Turandot]

26. Whether the charges on a hospital bill impact the actual payment..

received by a hospital varies widely, by state and by insurance companies. For example, Medicare pays hospitals based upon a fee structure which is effectively based upon the patient's diagnosis. They will send a patient an explanation of benefits (EOB) which may show $20,000 in 'covered charges', but that is not the actual payment amount to the hospital. Medicare payments to hospitals in every state are made this way. A hospital in NYC will receive more from Medicare for the same diagnosis than a hospital in South Dakota primarily because the 'base rate' is adjusted by price and wage factors which will be higher in NYC than in SD.

HMO's as well as commercial insurers in many states pay a 'rate per day'. That rate will not vary if you are there for an appendectomy vs open heart surgery. What varies are the number of days the insurance company will pay for. They will often attempt to not pay for the full length of stay of a hospitalization. 'Charges' will appear on an itemized bill, but if your insurer pays by per diem, the hospital gets that per diem multiplied by the authorized length of stay.

Medicaid payment methods to hospitals vary by state and are set by each state. In NYS, Medicaid uses a diagnosis system similar to Medicare.


Hospitals also admit patient for injuries related to auto accidents or work-related accidents. In NYS,those hospitalizations are paid for by a special auto-insurance system called 'no fault'; the work related admissions are paid for by workers' compensation insurance. A substantial amount of those types of cases get litigated, and even if they don't go to court, it could take a year for a hospital to be paid. There are rates associated with these two types of admissions.

In the examples above, the difference between the 'charges' on a patients bill and the actual payment received are written off as a
so-called 'contractual adjustment/allowance'.

There are states where insurance companies pay based on 'charges', but frequently, they have a contract with each hospital specifying that they will only pay a specific % of total charges. The difference between your bill and what your insurer pays can be due to that 'discount', not contested charges.

Outpatient payment methods vary wildly, even within NYC, but virtually no insurer covers the cost of running an emergency room, especially if the hospital is also a major trauma center.

A few years ago, after wide-spread complaints, NYS passed a law which made admission for mastectomies mandatory, at the patient's discretion. This was done because most HMO's were only paying for mastectomies as a one-day ambulatory surgery procedure, which was viewed as being unacceptable. It was a good law, with one small exception. The HMOs were not required to pay for anything other than the one-day ambulatory rate which they previously paid. The hospitals had to absorb the additional costs.

The one place where charges impact people directly are uninsured patients. In NYC, those patients are frequently people not poor enough for Medicaid. They are not cash cows. They often turn out to be bad debts. The state has a fund that compensates hospitals for some of these bad debts, but the percentage of coverage has been dropping like a stone.

The people who have a financial problem are the ones with some assets but no insurance. They are the ones who get the bills based on 'charges'. They may or may not be vigrously pursued by a collection agency since the costs of doing that can often be higher than the bill itself. At the moment, I believe there are a number of lawsuits in the system arguing the inequity of uninsured patients being billed on charges, while insurance companies pay lower rates.Hopefully those lawsuits will have some success.

But the reality is that something has to be done to pay for hospital costs. Those hopefully nice nurses who come to your bedside probably belong to a union which gives them a 3 to 4% salary increase annually. (In NYC.) They are the single largest number of employers by category for any hospital. The guys who clean the floors and cook the meals also get wage increases based on union contracts. Meanwhile, the insurers often do not have annual payment increases in their contracts. Medicare inpatient payment rates generally go up by less than 2% a year. (I'm referring to rates, not overall Medicare spending.)

I can't speak for every hospital in every state in the country. But in NY, an awful lot of them barely cover their costs each year, unless they are in areas with heavily commercially insured patients, income from endowments and a hefty donor base or generous Board of Trustees. Are there things that can be done to reduce costs at any specific hospital? Sure. Will those reductions make a dent in increased technology, drug and wage costs in every hospital? No.
But if you have a potential brain tumor, would you rather have it scanned with a 7 year old CAT scan machine or an MRI machine which produces far more accurate results (in color) that costs 3 to 4 times as much as a new CAT scan machine? One of the things that the US needs to come to terms with is that healthcare as we are accustomed to it, costs a lot of money. But in a way, why shouldn't it? It's the most critical thing in life for many people. The other thing that has to be addressed is that healthcare dollars should go primarily to healthcare, not shareholder profits. National and comprehensive heathcare coverage for all. That's really where the rubber meets the road, and so far the road is winning. But most of that road is insurance companies not healthcare providers or those evil trial lawyers.

I respect the fact that you have a different perspective based upon your own experiences.You no doubt have fallen into that group of people who admittedly get screwed the most by the payment system for hospital services. As I said above, hopefully some of the litigation underway in that area will correct part of that problem. My perspective, for whatever it's worth, is based upon working in healthcare finance for 20 years, both as a consultant and as a hospital fiscal manager. (My comments btw relate to hospital services, not physician office services, which is not my primary basis of expertise.)

[blurp]

42. Doctors also are forced by medicare to undercharge certain groups

For example, a doctor is paid $7 by medicare for the examination of a child. This is considered "paid in full". No additional charge to the patient or medicare is permitted. They must accept the $7 and that's the end of it.

[MsTryska]

37. I'm sorry but this isn't sitting right with me nor does it mesh with my

own experiences.


I've been on both sides of the fence - The Doctor's side and the headaches with medical billing and the cramp it puts on doing good medicine, as well as the side of having to go to the hospital, and have large bills, and not being able to pay them, AND doing this both with and without insurance.


matter of fact i claimed bankruptcy because of my medical bills.

However, no doctor I have ever visited has charged me more because i didn't have insurance than if i did. Matter of fact it's been the opposite. as soon as you "self-pay", they drop the price. I have also NEVER been to any practice that expects me to have the money upfront - they always give the option of being billed.


I also have never gone to a hospital that refused to treat me unless i paid them. Nor has my roommate who has had countless issues, and has never been insured.


Granted hospitals and doctors do try to collect (through their various collection agencies) but i've been carrying bills of one sort or another for well over 6 years now, as has my roommate and never have they actually called and harassed me to collect the funds. I just get letters every month.


Nor have i had the experience of them expecting the whole amount and not letting you arrange payment.

I would say yours is the extraordinary case, and it makes me wonder why you would see this same doctor for 10 years, if these are his practices, i can assure you across the board (in several different states and cities) this is not the case for the majority of health professionals i have ocme in contact with.

My best suggestion is to cut that doctor loose. His behvior, at least according to the standards of My father's generation of Doctors, is downright unethical.

[HuckleB]

38. Thanks.

I generally agree or acknowledge your experiences. However, I do have experience with practices expecting pay up front. The justification is usually to keep adminstrative costs down, by not having to chase down payment later.

As for your point about cash paying patients paying less, that's been my experience. In fact, more and more health care practitioners are going cash only, and are refusing to bother with insurance companies. They can charge much less because they have much less overhead. And they do quite well, as they treat small business people and others with only catastrophic insurance and uninsured folks for much less than other providers, while offering top notch care.

[MsTryska]

39. Yeah that is or perhaps "should be" standard practice...

even back in the day when my dad was practicing, he and all his cohorts charged less for self-pays, because it was a. the right thing to do, and b. the real price for their work. (they would have to inflate the bill for insurance in order to get almost the true amount back).



I've never run across doctors asking for money up front, except in the case of having to fulfill an insurance deductible, or going to an urgent care center. (which was run by another insurance company). I suppose it would depend ont he doctor and type of practice too. Were these standard fmaily practice/internists? or specialists?

[HuckleB]

40. It used to be mostly specialists, but the practice is increasing.

Especially as more and more health care providers balk at being on every panel (as they learn that the paperwork expected by certain insurance carriers takes up far more time than they get with the patients, not to mention simply having to wait six or more months to see payment, which is quite hard on small practices), more and more patients are being asked to front the bill and get reimbursed by insurance themselves. Some providers are doing all the paperwork like they used to do, and then giving that to the patient to send in to insurance. This still eliminates the follow-up labor costs in practices. Basically, it comes down to more and more health care providers doing everything they can to keep costs down for patients and for themselves in order to stay in practice. That's why this practice, which was primarily noted in specialties, is now seen more and more in primary care, along with the cash only providers discussed above.

Salud.

[MsTryska]

41. thanks for the info huckleb! nt

nt

[liberalhistorian]

48. Well, I don't know about

your area, but in my area good luck finding a doctor who won't expect payment in cash upfront if you're uninsured, they just don't exist around here. And my doctor of ten years started that last year, he didn't always do that. What pisses me off about that is that I've always paid in full, even during the times when I didn't have insurance, so he could have cut me some slack in that regard.

The first thing most doctor's offices around here ask is if you have insurance and what type it is; if you don't, they make it clear they want such-and-such amount in cash upfront, or they won't make an appointment.

And I was talking mostly about hospitals, and not doctors, when I said that the uninsured are charged more than the insured, that's a standard practice with hospitals. Insurance companies can negotiate discounts in prices with the hospitals, which is why the insured are charged much less.

If I were a doctor, I wouldn't even bother with insurance companies, I'd just do what you're saying many of them are starting to do, the fee-for-service instead of the insurance model. They would, indeed, be able to charge less and make more because they wouldn't have to deal with and pay for all the billing and paperwork, not to mention enduring all the headaches that come with dealing with insurance companies.

[MsTryska]

49. That sucks

that that's how they operate. I'm sorry to hear that, especially regarding a doctor you have a 10 year history with.


But question - are you hearing this from him directly, or is this coming from his staff?


Perhaps if you speak to him directly about it, or whoever his seniormost staff person is, they might be able to remedy it. Seems strange that you are unable to negotiate when you've been a patient in good standing for as long as you have. It might just be that he has overzealous billing-people.

[Bozita]

11. biggest underwriter of med/mal also owns NBC, MSNBC, CNBC

Name is GE Medical Protective.

http://www.consumerwatchdog.org/insurance/pr/pr004806.php3


home / insurance / press releases
NEWS RELEASE
Jan 10, 2005

CONTACT: Douglas Heller [phone] ext. 309

Connecticut AG, Doctors and Lawyers Call for Regulatory Investigation of Medical Malpractice Insurance Giant


GE Medical Protective Raised Docs' Rates 90% Despite 56% Operating Profit from 2000-2004

Santa Monica, CA -- Teaming up to challenge the near doubling of medical malpractice insurance premiums by GE Medical Protective, Connecticut Attorney General Richard Blumenthal, the Connecticut State Medical Society (CSMS) and the Connecticut Trial Lawyers Association (CTLA) called on the state Insurance Commissioner, Susan Cogswell, to hold a public investigation of the rate hike today.

Consumer advocates hailed the announcement, calling it an historic opportunity for doctors and lawyers to solve the problem of unjustified medical malpractice premiums by joining forces to challenge the insurance industry. Doctors and lawyers have typically been on different sides of the medical malpractice debate but could become a powerful force for insurance reform if the groups work together towards addressing high premiums, according to the nonpartisan Foundation for Taxpayer and Consumer Rights (FTCR).

"If you want to lower insurance rates, you need to investigate the insurance companies," said consumer advocate Douglas Heller, the Executive Director of FTCR. "With doctors, lawyers and law enforcement teaming up to demand insurance company accountability, Connecticut could pave the way toward real savings for physicians."

In July 2004, GE Medical Protective, one of the nation's largest medical malpractice providers, imposed an 89.6% rate hike on its doctors. Despite agreeing to conduct a second review of the premium increase, Cogswell has not held public hearings as had been requested after the hike took affect. It is believed that under public scrutiny the GE Medical Protective rate hike will prove to have been excessive.

An analysis of GE Medical Protective's book of business in Connecticut, found that the insurer has paid very little money for claims against doctors covered by the firm over the past five years. The company has realized operating profits of 56% since 2004, according to the study by AIS Risk Consultants.

The state medical society, in its letter, urged Cogswell to open up hearings to doctors and the public, because "many insured physicians have raised concerns as to the manner in which the rate was established by MedPro, especially in light of their reported loss ratio experience."

Connecticut, like most states, has little regulation of insurance companies, and physicians facing steep increases in their medical malpractice premiums have little recourse to block the hikes. Only California, as a result of the 1988 voter initiative Proposition 103, allows members of the public to challenge proposed insurance rate hikes before the increase goes into effect, according to the California based FTCR. In 2004, FTCR challenged a 29% rate hike proposed by GE Medical Protective for the firms' California physicians. The ensuing investigation led the company to decrease its hike by 60%.

"By opening the books of the insurers, it becomes apparent that the companies are gouging doctors around this country," said Heller. "Politicians, led by President Bush, refuse to take on the insurance companies and, instead, travel the country arguing that restricting the legal rights of patients injured by bad doctors is the solution to these premium hikes."

GE Medical Protective Says Legal Restrictions Don't Work

Around the nation, insurers hope to avoid scrutiny by funding a massive lobbying campaign aimed at convincing lawmakers that litigation by injured patients is the reason for the hikes. But, while lobbying to limit legal rights of injured patients by enacting caps on damage compensation, the companies argue against the value of such caps when pressed in regulatory hearings. In 2004, the Wall Street Journal reported that GE Medical Protective claimed that "the caps would lower payouts by just 1%" in a document it filed when it proposed a 19% rate hike in Texas soon after the state imposed a $250,000 cap on damages. ("Malpractice Insurer Sees Little Savings in Award Caps," October 28, 2004) A copy of the document is available at: http://ftcr.org/insurance/pr/pr004692.php3

"When pressed, insurance executives admit that legal restrictions are just a ruse. Hearings like the one proposed today would help clarify what is really going on in the insurance industry, and, before any states or Congress follows Texas to enact caps, they should follow Connecticut and demand insurance company investigations," said Heller.

- 30 -

[lawladyprof]

13. Well, some doctors continue to think of themselves as

professionals (members of a profession), but others have been "seduced" into seeing medicine/their practice as a business first. The same is true of lawyers and other helping professions. It is, I believe, a reflection of a culture that values money above all. Some DU'ers posting to this thread have only interacted with business-type doctors and others have the experience of having or having had doctors who were true professionals in every sense of the word.

One pressure new doctors face, that tends to push them toward the business model, is the need to pay back the loans they took out for their education (and the same is true for attorneys) and to recoup earnings lost during their extra years of training and underpaid work as interns.

[knitter4democracy]

24. Oh the loans!

We owe about $175K just for med school, so yeah, we chose to take a higher paying job in order to cover that (and pay it off before our kids got to college). Thank goodness, it's a good practice that really helps a lot of people. David just wishes that they'd take Medicaid--but the payments from Medicaid are so low that the practice would lose too much money per patient. It's not that these guys want to be rich, it's that they want to keep the doors open and the lights on. David's trying to talk them into taking a couple of his former patients from residency, though. He hates the thought of them having to go to someone new just because of their insurance.

Trust me, I hear about evil Pharma and insurance companies pretty much every night.

[shesemsmom]

28. I'll second most of that

Doctors tend to be repuks, at least around here they are, and if you mention national health care to them they go ballistic. You would be getting in their pockets, so yes they Doc share some blame

[liberalhistorian]

30. Actually, I don't understand why more doctors

aren't in favor of some type of nationalized guaranteed health care, because they'd actually make a lot more money. They could cut out the middleman, insurance companies, and they could drastically cut down on the number of employees who have to push billing paperwork and deal with the insurance companies. Those two factors alone take a big bite out of whatever they charge, and they could pocket that instead of it going to enrich already bloated insurance companies and to pay accounting employees. They wouldn't have to spend a lot of their time arguing with insurance companies, as they do now. They wouldn't have to pay collection agencies and give up a percentage of whatever is collected. They wouldn't have to wait a long time to receive payment from billed patients who themselves have to wait until they have the money to pay. They would actually be guaranteed payment, so they wouldn't have to work horrendous hours just to stay afloat. I really just do not understand why they don't see that. Since they see things mostly in terms of money anyway, why isn't this clearer to them?

This is what happened with Medicare and Medicaid. They were both proposed back in the 1930's, during the heyday of the New Deal, but doctors, through the AMA, vigorously opposed their implementation for over thirty years. They finally realized that they'd actually make more money with these programs, particularly Medicare, and then, and only then, did they accept it. The same thing needs to happen now.

[knitter4democracy]

34. I know many who are in favor of it or some version of it

The thing that scares them, though, is how bad the payouts are for Medicaid and Medicare. Any doctor who has a third of his patients or more (as reported in AMNews, granted) in Medicare just can't make it work. If all the patients were on Medicaid or Medicare, doctors would go broke. Stuff's just too expensive these days. I totally agree that we'd save billions in paperwork alone, but that's not the only cost of operating a practice.

[Tierra_y_Libertad]

33. Only poor people should be held "responsible" for their screw-ups.

Corporations and Doctors should be let off the hook. So sayeth our our political "leaders".

[fob]

44. You mean like the $800 charged for our son's overnight stay in

the nursery even though I refused to let him out of our sight and he NEVER went NEAR the nursery! That kind of "help". I hear ya.

[knitter4democracy]

57. That's the hospital, not the doctor, it sounds like.

I would contest it, personally.

[fob]

61. Yeah, that's the OP's theory. It's not the Docs or Nurses, it's the

Hospitals and FOR PROFIT healthcare!

Oh and that bill went about as far as it was actually worth - ZEROSVILLE.

[knitter4democracy]

63. I'm glad it wasn't paid.

For profit hospitals are actually illegal here in Michigan--against our constitution. It really helps, I think. Yeah, there's still crap, but it's not nearly as bad.

[EVDebs]

50. Drs. are expensive in the overall scheme of things....

http://careerfocus.bmjjournals.com/cgi/content/full/321/7259/S3b-7259

says: "Doctors are expensive: the average doctor's salary is still almost twice that of any other group working within the NHS (and four times that of a clerical worker). A report in Employing doctors and dentists suggests that employing physician assistants might be one way to get more value from that time; their numbers in the US are expected to double over the next 10 years to 87,000."

Putting all doctors on a salary as with HMOs like Kaiser may lower this a bit, as is importing doctors from overseas which we are seeing already happening. Why don't we just give doctors in training free educations in return for completion of their advanced degrees for openers ?

[liberalhistorian]

52. What you suggest might not be

a bad idea, especially considering the exorbitant costs of medical school and the fact that most doctors are saddled with hundreds of thousands of dollars in loans to pay back before they even begin their practices. That would seem only fair to me, considering that doctors are a critically important profession, but a profession that also has the most difficult education and training process of any other profession.

[knitter4democracy]

58. That's a start!

I wish med school had been free for my husband. Then we wouldn't have huge loans to pay back.

My husband's practice has a PA and two NPs, and they're talking about adding more. It really helps with the load. It's a pretty busy practice, and they follow their patients to the hospital, so mid-level practitioners really help.

[HuckleB]

64. Glad to hear Michigan is using mid-level practitioners that much.

It seems like the farther east one goes, the more ingrained in past tradition things are, leaving this valuable addition to health care largely out of the equation, despite a long and growing track record of safety and efficacy by them in practice. Of course, Illinios may be the worst for mid-level practitioners, so I won't completely pick on the east coast.

:)

P.S. -- I have enjoyed reading your very thoughtful posts.

[knitter4democracy]

67. We're enlightened? I just thought we were practical. :)

Mid-level providers are a great help. Those doctors need to talk to people who use them and see how much they really help the patients and the practice. I know David's call nights would be even worse if the mid-level providers weren't taking all the office calls so that he only has to deal with the hospital.

Thank you. Sometimes I've felt like I'm just ranting and annoying everyone. :)

[EVDebs]

59. Maybe just more personal responsibility as with the US diet would

help. I read somewhere about a book "The Magnesium Factor" that the US diet is woefully low on magnesium, and this is resulting in rises in obesity, diabetes, kidney stones, and especially heart problems.

http://www.penguin.ca/nf/Book/BookDisplay/0,,0_1583331565,00.html

This is mainly due to highly refined grains and other diet factors. If this kind of selfhelp information gets into mainstream media MSM, maybe certain diseases wouldn't be as prevalent.

We could be working with our doctors instead of against them and vice versa.

[knitter4democracy]

69. Have you read the Placebo Journal?

That's Doug's main beef--that we all end up paying for unhealthy behavior. Of course, he's also the first to admit that he doesn't eat right, either, so it's kinda funny. I highly recommend checking his site out if you want to read very dark doctor humor:

http://www.placebojournal.com

It's our favorite journal by far!