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Post by walter2 on Aug 29, 2013 8:04:20 GMT -7
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Post by kutkota on Aug 29, 2013 9:00:28 GMT -7
It is NOT socialized health care it is insurance reform. I will ask this one question - have you bothered to read the legislation ? I have a couple of questions of my own. How are hospitals reimbursed? Who sets the limits for which hospitals are reimbursed? What insurance provider is the largest insurance provider for Americans? Who controls that insurance provider? If you can not understand what my point is, it is fairly crystal clear to anyone that works in and/or understands the way in which healthcare is dictated. That would be by the insurance providers. Call it the blue moon project if you want, the mere fact that it is called an insurance reform act is the beginning of many final nails in the coffin, and it is all leading down the path of SOCIALIZED GOVERNMENT RUN HEALTHCARE!. To answer your question, no I have not bothered to read the legislation because my time is better used elsewhere. Let me explain and share what I have done. |
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Post by kutkota on Aug 29, 2013 9:38:10 GMT -7
I have spent the last 3 years of my life killing myself to achieve the highest GPA I could in my B.S. in Biology degree in my dream of becoming a physician. The pinnacle of that dream is/was to become a trauma surgeon. A little background if you will allow on the path to becoming a physician. You must have a 3.8-4.0 GPA, hundreds of hours of volunteer work, hundreds of hours of clinical work, hundreds of hours of physician shadowing, letters of recommendation from both the physicians as well as your professors in your field of study, be part of a research team that publishes an article in a peer reviewed scientific journal, and take the MCAT and achieve a great score. All of that to just GET to the interview at a medical school at which point they take roughly ½ of those whom they interview.
To become a trauma surgeon, you have 4-year undergrad, 4 years of medical school, an 8-year general surgeon residence, and a 2-3 year internship. So you are talking about 18 years after high school to become a trauma surgeon. Are you beginning to understand why only the supremely dedicated make it?
Naturally you don’t just jump into an endeavor such as that with out at least a small amount of research.
I have had the privilege of sitting in on multiple meetings as friends and family members set up a whole slew of healthcare business, medical as well as dental. One of the generally excepted practices of valuing a medical/dental practice is to view the previous 3-5 years aggregate business and from that you can extrapolate the approximate value of the practice. Of course you would not walk into a business venture without some experts in the field, so we gathered an entire team of experts in the fields of business, finance, real estate, insurance, legal, etc… to be part of these discussions as we/they are not experts in these areas they are experts in medical/dental healthcare.
An oddity I found was the number of practices making high 6 to low 7 figure incomes with no slow down to be seen selling out, and quickly. After talking with CPA’s, as well as one of the most renowned insurance experts in the state of Missouri the answer became clear.
If you would look at the two largest healthcare systems in Missouri and Illinois BJC and SSM you will see drastic cost cutting across the board. The main culprit is the economy, or at least that is what they are saying. The fact of the matter is that the census in the hospital in every field that is reported on is roughly the same if not higher than the previous years and is generally on track to hit the targeted goals for this calendar year. So then why the drastic cost cutting? The answer is given to me via the president of both the hospital I work at as well as the CEO of the entire BJC system and in so many words they are stating the government reimbursements have dropped dramatically and the 10-year outlook is not one of stabilizing but of decreasing nature.
WHAT…….. I thought with the new insurance regulation where everyone has insurance the payments from the insurance companies, the largest of which is Medicare/Medicaid and is ran by the government, would increase.
More later, books are calling.
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Post by walter2 on Aug 29, 2013 13:06:23 GMT -7
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Post by kutkota on Aug 29, 2013 14:41:16 GMT -7
First statement is false, and I completely agree with the second, but..... Posting what is believed to going to happen, as your first comment does, clear outlines the ignorance many have on this topic. In fact it is just the opposite, and the next time I am at work I will prove this to you with the hospitals own data points that have been produced. I'm not sure if it is online or not, if you don't want to wait feel free to google it. Theories, at least in the social arena are just that, theories. The hospital system I work at is in fact on pace to atleast keep up with the previous years. You can apply some statistics to those numbers and come up with just about any outcome you want, but at the end of the day, and if you are truthful, the numbers do not lie. I would appreciate any data that can be supplied as to the raw numbers of those seeking primary care in the ED in years past to as your statement elludes to "now". If the "now" you speak of is the present day it would be inaccurate as little to any of the legislation outside of the taxes for this legislation has been put into practice. To your second point, atleast before the but, I agree with. Once again, preceieved outcomes and real world outcomes are much different. My hospital system is spending millions of dollars on cosmetic renovations through out the entire system to please the patient. It is great grand and awesome. New floors, clean paint, new doors, windows from floor to ceiling, fancy water bottles, pretty paintings, etc. All is great, right? The real world implication is that we have to keep the patients happy right? After all that is a huge portion of how the hospital, and in turn the certified, and noncertified staff will be payed for. We have gone so far in the quest to prove to the patients that we truly care about them that we have pulled nurses off of the floor, taken them out of critical care, the ED, out patient areas of the hospital, and we have placed them into a patient advecute roll. Awesome, now we have a nurse that walks around all day, talks with the family members and the patients, gets them a wheel chair, or a recliner, cup of coffee, meal tickets so they don't have to pay for lunch or dinner, all is great. Families are happy, patients are happy, the world keeps spinning. BUT....... now the patient load per nurse goes from three patients per nurse to 5-7 patients per nurse! So now when we go in aat 1830 and start our shift we don't see the back half the patient population until 2230-2300. Timed medicine that is supposed to be due at 1900 now is not being given until 2200, 2300. What the heck, we have nice rooms, clean painted walls, awesome views out the 900 dollar windows but no medicine is being passed. No critical care is being delivered. Instead of really pouring into the patients chart, the patients reactions or non reactions to treatment, spending quality time with the patient and looking out for their best interest we are running like crazy trying to just get under the one hour we have to be late to pass their meds, just to run out of the room into the next patients room and repeat. This is at night mind you, during the day, it is pure crazyness. Doctors in and out, patients leaving for tests, PT, OT working with the patients, breakfast, lunch and dinner, cleaning up the patients when the are incontinent, or throwing up. But boy I tell you that cup of coffee that the at one time practicing nurse just gave you makes up for you getting your medicine 2 and a half hours late?! Right? Talking points only get you so far and then you have to apply the talking points with real world practice and you realize either the systems and processes work or they don't. The writing is on the wall, all over the millions of dollars in paint, and it is not very good. |
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Post by kutkota on Aug 29, 2013 14:53:03 GMT -7
The long and the short of the insurance bit, that I didn't get to previously is quite simple. The government sets the rates for what they will pay for procedure XYZ via medicare/medicaid and the rest of the insurance carriers 999/1000 times go along with those rates. What that means is that when XYZ is billed at 1000 dollars, medicare/medicaid immediatley denies half of it. Down to 500, then the negotiations start. Funny thing is that it is a pretty one sided negotiation and the hospital system is not on the winning end of it. Government reimbursement for healthcare is quickly declining bringing the rest of the insurance industry along with it. It generally impacts the patient very little as the hospital does not turn around and say, hey you owe us the difference. The hospital justs eats the cost. Reimbursement from the government to the hospitals will initially increase due to the increase in insured patients, and then as the costs continue to rise, the payments will be forced to continue to decline as the government simply can not tax enough to supply the demand.
The experts that are advising the friends and family, along with a number of the practicing doctors I have a relationship with are expecting a drastic cut in payments, proven by the continued decrease in payments from the government today, with out the obamacare legislation being in full effect.
That is why the high 6 low 7 figure practices are looking for ways out. If you take the 3-5 year average in ten years it will be much much lower as is evident by the declining reimbursement via medicare/medicaid and their million dollar practice will be worth 500 G's.
One of the many reasons I am rethinking my decisions on the healthcare field.
At some point you have to apply the thought process to actual practice, and if the logic stays the same, healthcare is ruined. The brightest stars will no longer be doing brain surgery, and reattaching limbs. Those that couldn't quite make it up to par and get into medical school will be because of the massive numbers of highly qualified Docs will be looking elsewhere.
But we have some damn nice paint and windows!
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Post by cajunlady87 on Aug 29, 2013 15:01:33 GMT -7
All I can say is wow! That's crazy and sorry you're being put through the wringer like that. Thanks for posting or we wouldn't know what's really going on behind the scenes. And yet people wonder why fewer are entering the medical field. Duh!
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Post by kutkota on Aug 29, 2013 15:11:11 GMT -7
All I can say is wow! That's crazy and sorry you're being put through the wringer like that. Thanks for posting or we wouldn't know what's really going on behind the scenes. And yet people wonder why fewer are entering the medical field. Duh! Noble intentions are only held in high regards of a few. If I didn't have a wife and kids I would still be going full steam ahead. Not being able to attend my sons baseball games, and my daughters volley ball or what ever the heck little girls play or do is simply not worth it anymore. I have a little journal that I write my thoughts down on and then hold myself to them, and when I first started going down this path I spent long hours really asking myself why I am doing this. When the wife and I sat down and planned it all out the money was never the reason. The genuine help of those in their darkest hour was on the top couple. That being said, 18 years of my life not being a part of my families life is not worth being a surgeon making 80 to 100 thousand a year. Cruel reality is that we only get one go at this and I want to live life, not just try to get through it. Knowing what I know now I am truly scared for the next several generations and I only hope and pray that calmer, logical heads prevail. |
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Post by cajunlady87 on Aug 29, 2013 15:23:46 GMT -7
I have a niece who is an RN and I like to remind her every so often my definition of drs. and nurses to give her a life after a long chaotic day. My definition is doctors and nurses who really care and show that they care are "angels on earth" and you obviously are one too.  |
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Post by walter2 on Aug 29, 2013 15:30:10 GMT -7
First, statement is fact.
Second, you called me ignorant even though you have not read any of the legislation.
Third, if all you are concerned about is how much money you will make Maybe medicine is not your best choice.
And a fun fact ; the USA is the only first world nation where it's people fear medical bills.
So where will our brightest stars move on to? Europe ? Where those pigs have socialized Heath care and take care of citizens Heath needs!
I bet all the doctors in those freeloading societies work for pennies and baked goods....poor fools.
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Post by jmarshnh on Aug 29, 2013 16:10:43 GMT -7
Ignorance of a topic does not make one ignorant nor does it imply one is ignorant.
Money was not a factor, if you read his post thoroughly he states that.
I am learning a lot from kutkota I did not realize and I appreciate his sharing his experiences. It appears this thread is becoming heated and maybe we should move on to better stomping grounds.
Or at least I am off to the circus
Jim
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Post by kutkota on Aug 29, 2013 19:08:15 GMT -7
First, statement is fact. Second, you called me ignorant even though you have not read any of the legislation. Third, if all you are concerned about is how much money you will make Maybe medicine is not your best choice. And a fun fact ; the USA is the only first world nation where it's people fear medical bills. So where will our brightest stars move on to? Europe ? Where those pigs have socialized Heath care and take care of citizens Heath needs! I bet all the doctors in those freeloading societies work for pennies and baked goods....poor fools. Yeah lol. Looks like I'm done here. |
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Post by kutkota on Aug 29, 2013 19:11:21 GMT -7
Ignorance of a topic does not make one ignorant nor does it imply one is ignorant. Money was not a factor, if you read his post thoroughly he states that. I am learning a lot from kutkota I did not realize and I appreciate his sharing his experiences. It appears this thread is becoming heated and maybe we should move on to better stomping grounds. Or at least I am off to the circus Jim Jmarshnh, Any questions feel free to ask. Unfortunatly with this subject alot of it is you don't know that you don't know. It's an interesting topic for me at least. I'm no expert but I know enough to be dangerous. |
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Post by jmarshnh on Aug 29, 2013 19:35:19 GMT -7
Ignorance of a topic does not make one ignorant nor does it imply one is ignorant. Money was not a factor, if you read his post thoroughly he states that. I am learning a lot from kutkota I did not realize and I appreciate his sharing his experiences. It appears this thread is becoming heated and maybe we should move on to better stomping grounds. Or at least I am off to the circus Jim Jmarshnh, Any questions feel free to ask. Unfortunatly with this subject alot of it is you don't know that you don't know. It's an interesting topic for me at least. I'm no expert but I know enough to be dangerous. Thank you sir, I will remember that. Jim |
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Post by walter2 on Aug 29, 2013 20:29:01 GMT -7
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