Monday, July 24, 2017

What is wrong with American healthcare? Nothing, expect, greed.

No one makes the argument for "Single Payer" healthcare, but, let me point to "Emcare" as the primary reason why there needs to be a massive change in the cost of healthcare insurance.

EmCare (click here)

Part of the problem with a political agenda that includes "Single Payer" is that the specifics are not discussed enough and there is too much wiggle room for lies and political rhetoric. 

Does anyone actually believe the cost of health care insurance is going to come down? Why should it? THE FREE MARKET SYSTEM is suppose to work to maintain costs. It will never work if there are companies, like EmCare, that simply don't care what they charge patients. They don't care. They want their money and they will get it.

Interesting though is the way EmCare is going about it.

July 24, 2017
By Julie Creswell, Reed Abelson and Margot Sanger-Katz

Early last year, (click here) executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done.

That’s when the trouble began.

Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code.

On top of that, the hospital, Newport Hospital and Health Services, was getting calls from confused patients who had received surprisingly large bills from the emergency room doctors. Although the hospital had negotiated rates for its fees with many major health insurers, the EmCare physicians were not part of those networks and were sending high bills directly to the patients. For a patient needing care with the highest-level billing code, the hospital’s previous physicians had been charging $467; EmCare’s charged $1,649...

EmCare is not an insurance company. It is not a hospital. It is a subcontractor for care that is given hospital privileges, in what appears to be, rural hospitals. They don't have to answer to insurance commissioners or any regulation, they simply decide if they want to purchase their next yacht and charge their patients accordingly.

That is clever. Very clever. EmCare is in emergency rooms. Not surgical suites, but, the most delicate place in a hospital where life and death are in the balance.

How do they do it? 

July 24, 2017
By  Mike Cummings

A new study by Yale researchers (click here) of more than 8.9 million visits to emergency departments (EDs) reveals that a small group of predominantly for-profit hospitals in the United States have the highest concentration of out-of-network ED billing rates: While 50% of hospitals have out-of-network billing rates below 5%, 15% of hospitals have out-of-network billing rates above 80%.

The researchers previously found that 22% of privately insured individuals who went to in-network hospitals were treated by out-of-network physicians and thereby potentially exposed to significant unexpected costs. In their new study, they also found that recent legislation in New York State has been effective at reducing the incidence of out-of-network-billing, but that policy makers could do more to better protect consumers....

The billing comes from EmCare as an OUT OF NETWORK provider. A healthcare insurance consumer may very well seek pre-approval even on the way to the ER, but, it doesn't matter because the physicians treating him are not in network.

In California, dialysis centers found they would be paid better if their patients were not on a government medical insurance program. They took it on themselves to see to it their patients had health care insurance from the exchanges. There was nothing illegal about it. It caused the cost of healthcare to increase.

If Senator Bernie Sanders is looking at the same paradigm shift I am, there is no answer to the corruption entering the healthcare industry spawned by greed.

Physican groups such as EmCare will drop out of insurance carrier after insurance carrier to bill independently as Non-Network providers.

Single Payer is not about ideology. Single Payer answers this level of corruption with a solution and that is what Senator Sanders is looking at. No matter how many provisions are built in to the Affordable Care Act to bend the cost of health care down, it won't happen because there is too much greed and corruption in the costs.

The Affordable Care Act didn't seek to change the infrastructure of health care delivery, it sought to support it while containing the costs and over time reduce the costs to consumers. Some of that belongs to Americans. If they take advantage of their free annual physical and take their physicians advice the cost of health care will come down because of a healthier America. That is still in play, but, emergency rooms are emergency rooms and EmCare chose the one place in the hospital that no matter how healthy Americans become they will still need emergency rooms.

Single Payer would insure all Americans. It would contain costs by the fees it pays for services including practicing physician SALARIES and not simply COSTS. A physician would receive a salary like any other professional in this country, except lawyers.

The fraud will stop because the billing and fee schedule will be simple and straight forward.

Why don't Republicans want this? The obvious answer is that Wall Street would be hurt by such a system. But, it is more than that. Physicians are among the largest political donors in state elections. Not federal, but, state. If all the physicians in a given state are receiving basically the same salary (specialists would be paid more) who is going to pay for political favors? What would the political favors be? Raise in salary? Nope, that is not a concern. Whenever a salaried person is working directly for any government there are unions to guarantee outcomes the members are looking for. Physicians would have unions to protect them no different than workers on production lines. 

Single Payer will end the abuse of the USA health care system and begin to address the needs of all Americans. For those running for office in support of Single Payer, they will need graphs and charts to explain how it works and where care will be better with lack of corruption and of course the US dollars involved. There are aspect of Single Payer that is not a hard sell.

The other company mentioned in the Yale study is "TeamHealth." (click here)

Two companies. ONLY two companies that specialize in Out of Network physicians. ONLY TWO, causing all this grief to Americans. This MUST be addressed before the entire system is out of sync with reality and the TRUE cost of healthcare.


Love what you do, plus where and how you do it 

TeamHealth recruits everyone from residents to Advance Practice Physicians. They do not specialize in one department of the hospital to place their Out of Network Clinicians; they place them in the ER, OR, Anesthesiology, Hospital Medicine and its sub-specialties, behavior health, ambulatory care and Post acute care. Oh, is that all? Why not just staff an entire hospital and bill patients directly for OUT OF NETWORK costs.

Hippocratic Oath, Modern Medicine (click here)

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.