Interesting step on doctor costs taken by Aetna

Here is a link. Heard about it this morning on the radio. They're posting costs negotiated by Aetna with different Cincinnati doctors for procedures.

http://www.aetna.com/news/2005/pr_20050818.htm

Where do you think this might lead?

Richard

The Harbor Freight of Medical Clinics?
Good idea, but discount doctors don't seem
appealing, just like I would rather have $100
an hour riggers moving my machinery than $25
an hour ones.

You misunderstood the article. It is for disclosing the costs of doctors, not influencing you to buy cheap, per se.

Richard

This *might* be the start of a good thing. As things are now, it's next to impossible for a person to compare prices charged at medical offices.

About a year ago, I determined we were actually paying 60% of the amount charged by any given doctor visit. Our insurance said it covered 90% of the bill, but the trick was that the the doctor's office billed one rate to us and another, much lower rate to the insurance. Ten percent of what they billed us was equal to an average of 60% of the rate charged to the insurance company.

To minimize this 60%, I called around town to try to get doctor offices to tell me what they charged to see a doctor. Most didn't want to reply at all, and the ones that did respond generally said it might be this plus that, then maybe this, then maybe that could be added, etc. It was generally impossible to get them to say what it actually cost to simply see a doctor for even a very specific question. An article the local newspaper just commented on the same thing - that a person simply can't compare medical office costs.

Right. I can't think of any other thing that I sign a blank check for and then ask they payee to assess the costs. I think this could be the start of something good. Either good or bad, I think this will get outside of Cincinnati.

Richard

Doctors seem to get most of the blame for high costs, but in reality its the hospitals that are driving medical costs thru the roof.

There's an opthalmology practice here in town that was located in maybe 8000 sf of office space for years. About 5 yrs ago they built a new 66,000 sf office in a new medical office park, and included facilities for doing procedures like Lasic and cataract surgery, and other similar things in house instead of at the hospital. Since then, they've added another 20,000 or so sf to their facility and have purchased the entire medical park. Just gives a graphic example of how much money they can generate once they were able to collect the part of the bill that was normally paid to the hospital. The local hospital has been majorly pissed off about this due to their loss of revenue, but IMO if the hospital hadn't driven their own costs so high by operating like a government agency instead of like a business, they wouldn't have created a situation that made it attractive for these docs to bring the procedures in house and get both ends of the money. To me, these guys are just good businessmen who saw a situation of high costs and gross waste, and used it to make a lot of money by operating the same service as a business should be run.

There was an article in the local paper about a week ago that mentioned some of the billing rates for various services at the local hospital. For example, speech therapy, which is a job that pays maybe 35K/yr, is billed to the patient at $235/hr. Respiration therapy, a job whose skill set would classify it as semi-skilled in any other industry, is also billed at a similar rate, plus supplies of course.

Hospitals are continuously jockeying to obtain the max political clout in their area. The hospital system here in Asheville is the largest employer in NC west of Charlotte. Look at a map and you'll see that's an area larger that a lot of entire northeastern states. Insurance companies are very politically and clout conscious, so they focus on beating down doctors' costs since its easier than taking on someone the size of the hospital system. A guy I know who's an Internist told me recently that for a particular lab procedure he gets $11 from the insurance companies, makes maybe 2 bucks on it, and had to fight to get the $11. The same insurers are currently paying the hospital system $65 for the same procedure. Some doctors do make a lot of money, but I'd say on average they make less than we the public think they do. The risk is high and the operating expenses are high. The "divide and conquer" theory makes them easy targets for insurance companies because everyone knows they live in nice houses in nice neighborhoods and have gotta be getting filthy rich, while "the hospital" doesn't even have a house. Be that as it may, IMO its the hospitals and not the docs that are the major drivers in high costs.

Several insurances are doing this "find the best doctor" scam right now and basing it on how much the doctor spends on tests. United health just instituted this and calls it "preferred providers". Bottom line is that the "preferred providers" are the doctors that don't order the tests, if they are needed or not does not matter to the insurance company. It's a game called who spends the least.

If you go to a non-preferred provider your co-pay is much more. It's all incentive to drive the aggressive and thorough docs out of business. In the end only the insurance company wins.

"preferred providers" - yeah, preferred by the insurance company!

When ever I read about health care in the U.S I remind myself how thankful I am to live in Canada with Universal Health care that is top quality and free.

Frederick, guess you don't have any real medical problems or live in Calgary, cause I have a friend up there who just lost most of a leg to juvenile diabetes after waiting 6 weeks for a hospital bed after they closed one too many hospitals up there. If that's top notch care,I'll pass on it. As messed up as the medical system here is. with all it's price gouging,and insurance company parisites, that simply would never have happened here.

There ain't nothin free in this life, including medical insurance. You'll either pay for it out of pocket or pay for it with taxes. The reason people think it's free is because they never see the money, it's just gone from their paycheck. They think they have free health care in Holland too, where they pay 55 percent income tax straight across the board. That's what illicit drug legalization will do for you, but that's a rant for another topic.

Having said that, I think the only way to even start to straighten out the medical system's mess in this country is to cut the insurance companies out of the loop. I consider these people parasites,vultures, pond scum, and a few other terms I can't type here. You may think I'm nuts, but I'd like to see some of the top management of these outfits on the street begging for food, because that's just about the position they've put thousands of of other people they've provided their "service" to in this country in after these people paid their premiums for years and never had a hint of a health problem. One day they do, and these companies can't dump them fast enough. If you get sick, they don't want you sick long term, they either want a quick cure, or they want you dead. It's just as simple as that.

There is no way on this earth that anyone can convince me that a well planned government healthcare system with taxpayer oversight,ie a vote,which you sure don't have with the insurance companies, can't do better with less of a bureacracy involved than either Canada's messed up system or the european's equally messed up systems.

Even if there had to be a sizeable bearacracy, anyone would be hard pressed to convince me that it'd be either less effective or more expensive than the parasites who control medical insurance in this country now. Good God, how much worse does it have to get before people just say enough. The best thing about it IMO is that EVERYONE would pay for it. You wouldn't have 20 somethings skating along free with no insurance, getting maimed for life on their crotch rockets and all the other irresponsible stuff kids do, and then I and everyone else have to pay higher and higher premiums to make up the difference. Mr crotch rocket self maimer would damn well shoulder his part of the burden whether he wanted to or not. Of course that's just an example of one more problem to be solved in a national healthcare system, the problem of personal responsibility, which none of the other national healthcare systems I'm aware of have addressed, and I'm convinced that one way or the other, healthcare in this country has to be addressed, and has to be changed radically, cause the systems broken and IMO, slapping band aids on a system that only benefits the fatcats who run BCBS etc, and the politicians they funnel money to can't be fixed, it just has to be done away with.

I should have described the system as a universaly available tax supported system because you ar right it most certainly not free. I am reminded of this every time I make a purchace and pay 15% sales tax. Despite the Tax I am thankful on a daily basis that I Have Canadian Health care

Frederick, guess you don't have any real medical problems

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Actuly the opposite is the case . Someone very close to me is going throught treatment for breast cancer. Let me give you a time line for the treament so far and I think you will agree that the treatment has been timely and first class. On discovering an area of concern she went to her family G.P. who recomended a mamogram which he was able to schedual for 2 days later. The results from the mamogram indicated a bioppsy should be done which was schedualed 3 days later . It takes 5 days for the lad to culture the specimen and give a result to the G.P. who called her in the day he reeived the result and schedualed an appointment with the surgeon for 2 weeks later . After seeing the surgeon for an in itial consult on a tuesday the surgery was schedualed for Thursday of the same week. 2 days later. Chemotherapy started 8 weeks form the date of surgery which is right on the recomended time according to the latest studies.

This is the level of care available to all Nova Scotians rich or poor irrelavent of wether they can afford it because it is a tax funded system available to all Nova Scotians.

I know that the Canadian system is not perfect and there are sometime shortages the lead to tragidy

As messed up as the medical system here is. with all it's price gouging,and insurance company parisites, that simply would never have happened here

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That may not have happened to someone who was wealthy or had first class full coverage insurance , but in the U.S. there are far more cases of tragidy because some one simply did not have health care available to them due to not being able to afford it. In the U.S. ther are millions of people who have virtualy no access to quality medical care due to cost. I know that there are various programs that provide medical care to those who can't afford it but I don't think you would be impressed with the quality or the wait involved

Where is the "latest study" that says that two months from suspicion to treatment for breast CA is OK?

Let me guess it was sponsored by a grant from the Canadian government?

UHC got canned by our local (in top 10 in US) medical center, BJC, for just that preferred deal.

The second local center also canned them.

The third local center discovered that UHC was paying less than Medicaid pays....and was in the process of canning them.

UHC seems to have backed down, since the cannings have been canceled... but it seems we are back to the HMO mentality of "let a few die, they are too expensive for us anyhow".

The last thing I would want is government health care.... lowest common denominator...

If run like the unemployment office, or the welfare office, it would be a disaster... And that is exactly how it WOULD be run.

Government "fairness" means "we treat EVERYONE like $hit".....

Where is the "latest study" that says that two months from suspicion to treatment for breast CA is OK?

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You have misread the time line. The 8 weeks is from the time of surgery to the start of chemotherapy. agressive treatmeant starts with the surgical removal of the tumor. The 8 weeks is a balance of giving the body enough time to heal and recover from the surgery before introducing the chemotherapy drugs which drasticly affect the bodys healing ablity and immune system. Chemo needs to start as soon as possible but if it prevents healing from surgery it leads to other probems.

If run like the unemployment office, or the welfare office, it would be a disaster... And that is exactly how it WOULD be run.

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One of the biggest misunderstandings of the Canadian system is that most G.P.s do not work for the goverment. Most G.P.s are infact independent buisness men or are involved in small partnnerships with other doctors. They own or rent there own offices and hire there own staff, set ther own hours and decide how many patients that they will see. Where the goverment comes in is that all medicaly necisary services are billed to the goverment billing agency acording to a fee for service schedual. The doctor who is often incorperated is respocible for all own his overhead costs and expences as any other buisness man is. Since the doctors are independant buisness men they can choose to work as many or as few hours as they need to cover there overhead and provide the income they wish. The only contact the patient has with the goverment billing beuracracy is the very ocasional letter which is sent out to check if a billed service was actualy provided as a fraud prevention measure.
Ther is absolutly no requirment by the goverment that A patient see a particular doctor because they live in a certain area etc. A patient can see whatever doctor they choose providing the doctor has time to see them even if the doctor is at the other end of the province. Further more if you are unhappy with a particular doctors opinion you are free to visit a diffrent doctor for a second , third , fourth , fith etc opinion.
One of the biggest diffrences between Canada and the U.S. is in Canada the Doctor is the final authority. In Canada when you visit your G.P and he thinks a specialist visit or further testing is necisary and writes out an order you get it period. There is no review by an insurance company or H.M.O. What the doctor recomends the patient gets. there may well be wait involved for some tests or procedures but there is no healt service beuracracy to deny the tast.

Ah. That makes more sense.

It used to be the wages a doctor made were driven by their local economy & doc's fared not much better than anyone else. With the rise in health insurance paid by employers during the 50's and after; local wages/economies didn't matter as much, procedures were billed to reflect what the insurance would cover.

The Doc's use a rate book from the AMA, doesn't matter what the average wage in town is. I'd say its' "price fixing," or it would be called that if you and your fellow small shops got together and decided to charge exactly the same rate the same rate. Lets be truthful, it costs less to provide medical services in a small town than a big one, and costs less to live there.

I have a very close relative who is an MD. His practice, as routine, shuffled patients without insurance or ability to pay, to someone else. He also thinks the license to practice medicine is also a license to make at least $250K. yearly. Forget any emergency in the night. He often complained about people in the neighborhood who would come over, or call, with some medical problem and refered them to the hospital. I once saw him change direction when a guy had a heart attack at a community picnic, saying the EMT's would be there soon. I was also present when he took the oath about treating all the sick, regardless!

I feel very strongly that what is wrong with our health system is greed from the Doc's, way to much dished out at hospitals to people who aren't even citizens, and yes, their birth rates are often much higher than ours (babies aren't cheap anymore). A lot of hospitals are private, even when they have such names like "Town name-Community Hospital," few go out of business due to lack of revenue.

The high charges are often defended based on dealing with human life. Guess what, so do Airline Pilots and Bus drivers, neither of which make nearly the wages a Doc gets. The years of education, well many other professions also require the same years in school but don't have someones insurance to foot the bill, and their wages are lower.

At least the insurance companies are trying to buck the excessive cost and are refusing to pay over certain amounts these days. In time, you and I, will also balk or refuse to pay because we just can't. Then the health care costs will come down.

My $.02.

I am under Aetna with my retirement plan, which their benefits are eroding away. I have lived under the Canadian system, in Quebec, where private insurance was banned until recently.

Both have pluses and minuses to them. But Aetna when I retired paid a whole lot better and had more doctors accepting their payments than today.

My retirement folks keep saying be glad we have benefits. Plus they complain that they have to pay more than us retirees. I keep reminding them when I came here, healthcare was free. That was about 18 years ago.

Jerry

The problem with Healthcare in the states is the healthcare management companies are a new profit layer in the medical scheme of things. Plus some hospitals are offering insurance if you go to their family practices clinics. So they are the hospital, the provider and the insurance company as well as the healthcare management. Something is wrong with that setup, but it is happening more often.

I think Kaiser invented that system.

Jerry

Don't get the post I started this with wrong. I'm not knocking doctors or anyone, I know they put up with crap that I certainly want no part of.

My best friend who recently passed away was an RN in charge of his hospital's emergency room. He told me stories about crack whores giving birth at NO COST to them. Also an unwed illiterate teenaged mother with a no-name baby, taking it to the emergency room because it was "just crying." She'd been there before, at a cost to taxpayers of $250. They gave it a Motrin pill and advised her to give it more when it cried. She returned for the next pill, having lost the others given her, that was why she was back, and the next pill cost the same amount. My friend dug .22 bullets out of the necks of gang members, again at cost to taxpayers.

Richard