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Imaging And Primary Care Doctors

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[…] When Jay hurt his knee a couple years ago, an MRI was done prior to surgery. We have an HSA qualified health insurance policy, and at the time our deductible was $3000. So we paid for the MRI ourselves, and it amounted to more than a third of the deductible. And that was after Humana reduced the bill to the network negotiated amount. MRIs have helped to make medicine a much more exact science, but they are not cheap.

It seems that any system that pays physicians – directly or indirectly – to order additional testing will end up with excessive testing, adding to the overall cost of health care. Even doctors with the best of intentions are likely to be swayed by the knowledge that they can boost their paychecks by adding a few MRIs here and there.

I believe that the number of tests a doctors orders should not impact his or her income. And it seems that adding more medical imaging facilities in primary care offices will only increase our already burgeoning health care costs […]

Conflicts Of Interest In Health Care

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[…] Hospitals are in business to make money, just like most of the other players in the health care industry. And hospitals have boards of directors. We know this, but do we know what they do, or who they are? Dr. Roy Poses of Health Care Renewal has written an article about hospital boards that might make your blood pressure rise a notch or two. […]

Illegal Immigrants And Health Care Reform

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Both sides are fired up about this, and it’s a very contentious issue. We’ve already had the abortion issue get dragged into health care reform, and now illegal immigration has added more fuel to the fire. Some people might be uninterested in health care refom otherwise, but when you start talking about things like abortion and illegal immigration, it gets attention. […]

Some Claims Should Be Denied

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What if they refused to pay for some of the CT scans being done at a clinic that purchased its own CT scanner and subsequently had a 700% increase in the number of scans ordered? Would the health insurers be held up as the bad guys, for not paying for the scans? I have to imagine they would, even though it’s likely that a good number of those scans were unnecessary. […]

Physicians, Not Providers

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I wonder how many times I’ve used the term “primary care provider” on this site? I try to be as PC as possible, but I never knew that term wasn’t appreciated by the doctors to whom it refers, until I read an article by Dr. Toni Brayer at ACP Internist. It seems the term primary care provider was created by health insurance companies, not doctors. […]

The Drug Industry Is Dancing

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[…] Drug costs have played a major role in driving up health care costs over the years. Many of the health insurance companies we work with in Colorado now require a separate pharmacy deductible to be met before copays kick in for drugs. And then I read articles that describe how psychiatric drugs have become common-place in our society. I think there’s a connection here somewhere…

Responsibility For Patient Health

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[…] Would an outcome-based payment system mean that doctors who treat chronically ill patients wouldn’t be reimbursed as well as doctors who treat people who can fully recover from whatever illness they have? Would doctors be less likely to take on chronically ill patients? Yes, we should take responsibility for our own health. But what if we get sick anyway?

Overutilization Of Healthcare

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[…] Was my friend’s doctor practicing defensive medicine? Probably. Was she just trained to see problems, and thus spotted one that turned out to be nothing? Whatever happened, it absolutely had an impact on the healthcare costs associated with my friend’s pregnancy and birth. Eight extra ultrasounds and 24 hours of testing and monitoring in the NICU are not cheap. […]

Yet Another Out Of Network Charge

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[…] it’s all fine and good for a surgeon to have assistants, but doesn’t it seem that those assistants should be part of the same health insurance networks as the primary surgeon? After all of the effort we went through to make sure that we wouldn’t get hit with another out of network charge, this is frustrating to say the least.

Medical Mistakes

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[…] I believe that most people who become medical providers do so out of a genuine desire to help people. But then they get caught up in paperwork, health insurance regulations, overcrowding and under-staffing, malpractice litigation fears, and a whole range of other things that don’t really have anything to do with providing care. I was struck by how many articles mentioned sincerely listening to patients as advice for providers.

Free Health Care For Some Laid Off Workers

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[…] It’s laudable that the clinics are offering free health care at all; they have to structure this in such a way that they don’t end up driving themselves out of business in the process. By requiring that a patient (who might think that a job/health insurance loss is on the horizon) come in for a paid visit first, the clinics will likely boost their revenue in the early phase of this program.

Paying For An Office Visit

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[…] Some people don’t have a car or health insurance, especially in our current economy. Programs like Medicaid and Colorado’s Child Health Plan Plus are very necessary, and I support efforts to expand those programs to more low-income families. But there are people willing to pay more than $150/month for a car, but hate the idea of paying $150 to see a doctor. […]

The Conscience Clause And Access To Healthcare

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[…] Instead of requiring doctors to provide services that go against their moral beliefs, why not work to make sure that every community has providers who will perform a wide range of reproductive services? If clinics like Planned Parenthood get adequate funding, doctors practicing nearby could invoke the conscience clause without depriving the community of medical services.

Doctors and Patients and Healthcare Reform

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[…] Our system doesn’t reward doctors who spend time with their patients. Instead it rewards doctors who see the most patients in the least amount of time (writing a prescription for an antibiotic is a good way to move patients along). Expecting change to come from patients isn’t fair. But it’s also not fair to expect change to come from the medical profession as a whole until we make some changes to how doctors are reimbursed for the services they provide.

Audits For Medicare Providers

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[…] most doctors are trying to provide the best possible care for their patients and simply get paid for what they do. Medical billing is fraught with complications and headaches. To eliminate mistakes, it seems that making the billing system less complicated would be a better solution than audits. […]

The Real Price Of Brand Name Prescription Meds

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[…] If a rep presents a new med to a doctor, mentions that it’s a whiz-bang drug, and brushes the cost off by saying something like “it’s a brand name drug, but the copays on brand names are usually only about 20 bucks more than generics” the fact that the drug actually costs more per month than most car payments will probably not factor into the doctor’s prescribing decisions. […]

Women And Healthcare

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[…] If you’re up for a little controversy, PalMD at White Coat Underground has written about conscience clauses that allow medical providers to refuse to to provide care if it conflicts with their personal beliefs. A very good point raised in the article and comments is that the conscience clauses tend to be invoked in matters of reproductive health. […]

Customary Charges Are Not Always Reasonable

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[…] Pricing varies from one provider to the next; negotiated reimbursement rates vary within a single health insurance network; patients often don’t know what the price will be until after the fact. And as David Williams pointed out, the prices are often far from reasonable. We can’t do without healthcare, and that’s why unreasonable “reasonable and customary” charges exist.

Healthcare IT Not Just About EHRs

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[…] Instead of expanding EHRs, they suggest relatively low-tech IT solutions that would provide more bang for the buck. Their ideas include an on-line method of sharing medical records between PCPs and specialists, expanding the use of email between patients and doctors, and enhancing broadband access across rural and low income areas of the country. […]

No Nurses In The Unemployment Lines

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[…] I know that some hospitals are struggling to make ends meet and are unable to boost benefits or pay for their nurses. But why are some hospitals spending money on artwork and spa services when there’s a nationwide shortage of nurses? Why not channel that money into recruitment efforts, education grants, and higher salaries and benefits for nurses? […]

Your Health Insurance Company Prefers Generics

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[…] But even if you have coverage for brand name prescriptions on your policy, asking for a generic will likely save you money. And it will save your health insurance company money. They are well aware of that fact, and apparently employ a lot more tactics than most of of realize to get doctors to prescribe generics and patients to request them. […]

Most Americans Unaware Of PCP Shortage

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[…] People whose employers pay the majority of their health insurance premiums are often unaware of just how expensive health insurance really is. People with health insurance are often unaware of how expensive health care really is. And people who aren’t experiencing a PCP shortage in their own lives tend to be unaware of the overall PCP shortage. […]

The Art And Science Of Choosing Providers

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[…] Provider quality rankings are a piece of the puzzle for sure, but they’re not the only piece. I do think they will get more popular if health insurance carriers start actively encouraging patients to select from among the highest ranking providers. But there are other factors that go into choosing a provider that can’t be quantified on a spreadsheet or a graph.