Health Care
- Thread starter Syskatine
- Start date
Whatever gets us down to Medicare actually paying what providing care costs. In 2017, Medicare paid $0.87 for every dollar SPENT caring for beneficiaries.
So, nursing? Diagnostic imagining? Housekeeping? Surgical survices? Laboratory? Wait times like Canada? Meeting standards required by Joint Commission? Outdoor hospital tents? Physicians?
We also have to factor in that many hospitals use their excess operating income to purhase capital equipment and upgrade their facilities. Who am I fooling? All hospitals use excess operating income to purchase capital equipment and upgrade their facilities. So we're going to have to cut more than $0.13 for every dollar currently spent. Hospitals need about 3.5 to 4% excess operating income to fund the capital stuff reliably.
Someone needs to talk to a doctor and ask if they could keep their practice open if all they received were the current Medicare reimbursement rates. I have talked to several and to a doctor they have all said they would be forced to close their practice.
This is mostly correct. You can't keep a business open when all your payors don't pay enough to cover the actual costs.
This is one of the reasons many physicians have started to become hospital employees. The hospital takes on the practice overhead and can manage the practice more efficiently because of scale. The costs of maintaining a private practice independently are becoming too much to continue for many. But strangely enough, when the hospitals that employ physicians can't afford to pay them because the reimbursement for the physician doesn't cover the cost of the physician providing care, that arrangement won't work either.
What are the costs? And what do you think a reduction in payments will do to those costs?
How does a reduction in payment reduce costs unless you reduce the services that create the costs?
Hypothetically, if you were on a hospital board and everyone switched to medicare reimbursement rates across the United States, what would your first move be?
What would yours be? I work in healthcare. I know what Medicare reimbursements actually look like in regards to operations and budget.
Exactly the same thing I would do.
Did you know that healthcare has been taking a hard look at costs for years now due to the ever shrinking Medicare and Medicaid reimbursement dollars?
Are you also aware that there is an increasing mountain of unfunded governmental regulation that encompasses healthcare? EMRs should be a great study for you in this area.
Are you aware that private health insurance is what keeps hospitals and physicians afloat?
Are you aware that in many cases, cutting costs in 2019 means cutting services?
Are you aware that in 2019 access to healthcare is worse than 10 years ago due to the closure of hospitals that had a high Medicare and Medicaid payor mix?
Are you aware that utilization is always increasing?
Are you aware that decreased access negatively impacts mortality and morbidity and actually increases the cost of delivery?
Are you aware that obesity and the chronic health conditions that it causes increases costs of providing care compared to a non-obese person?
Are you aware of the wage pressures that $15 an hour burger flippers put on those that employ skilled labor?
Are you aware that the healthcare industry strives for better outcomes and there's always an unfunded cost of doing so?
I could go on, but I think you'll be busy for a while looking into all of that to get a better picture of what "cutting costs" looks like.
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Like what? Supplies are sold to the hospitals at around 2-4% over cost. They can’t go lower.
Fixed costs like facilities, salaries, insurance, personnel are pretty much cut to the bone.
You can’t cut much more without really hurting services. Watch how many hospitals close in the next five years. Rural health will be hardest hit. If you reduce Medicare rates by 40% you will get 3rd world health care.
"
• A U.S. heart bypass operation costs on average $75,345, according to recent data, compared to $15,742 in the Netherlands and $36,509 in Switzerland.
• A CT scan costs $896 on average in the U.S., versus $97 in Canada, $279 in the Netherlands and $500 in Australia."
Oh word? We've been really looking into costs.
If you think those are fixed costs, just wait until we have medicare reimbursement rates across the board.
There's always fat to be trimmed until there isn't. Some hospitals and health systems operate very leanly, some not as leanly.
What happens when every ounce of fat is gone and it still doesn't make up the gap? Can your business, whatever it is, operate at a loss every year and keep the doors open?
Can you find me someone who will do neurosurgery for $120,000 a year? How about an interventional cardiologist for the same price? Orthopedist for maybe $100k? Anesthesia should be easy. $80k for physicians, $50k for midlevels? I'm sure everyone will be jumping on the ER physician train for $80,000 per year.
How about a registered nurse for $24,000 a year? Maybe an ultrasound tech for the same price? Physical therapists will do it on the cheap, maybe $30,000? Pharmacists, what do they do but count pills anyhow? $35,000 will get the good ones on board.
Any $800,000 128 slice high resolution CT scanners out there on ebay? How about a $50,000 DaVinci robotic surgical system? I'm sure a ProFix pelvic surgical table can be had for $5,000. Remote cardiac monitoring? We could put someone who can read ECGs in each room, but we're trying to cut costs here. I hope Spacelabs or Zoll has something for much cheaper than the $2.8 million we're getting ready to spend on a system after steep discounts to utilize only onevsystem to cut costs.
Can we get a competent CEO for $60,000 a year? How about a CFO for $50,000 a year? Should hospitals just have nobody in charge? Maybe we can staff ICU's at a 1:10 nurse to patient ratio rather than the 1:2 nurse patient ratio that's recommended for patient safety and outcomes. No balloon pump patient needs a nurse most of the day anyhow. We can just shift that workload to the family and patient.
If you're just going to operate with Alexandria Occasional Cortex and Bernie talking points and complete ignorance on the subject, I'm not going to waste my time.
Why does a shitty one bedroom apartment cost 2500 a month in New York City and 600 in Oklahoma City?
You can play this game all day, but the fact is large idn’s are in big trouble. Barely profitable. They can’t all be horribly mismanaged.
It appears like you are secretly smirking, because you have the answer. I’d love to hear your thoughts. I just sat through a presentation from the very independent health advisory board. They’re concerned. Very concerned.
The unsourced graph tells a complete picture. I'm sure declining revenue from Medicare and Medicaid has nothing to do with price inflation to make up the losses by charging higher prices to collect more from private health insurance. I'm sure it also has nothing to do with the increasing costs of R&D to bring new technology, drugs, and devices to market. I'm sure it also has nothing to do with an ever unhealthier population who is more litigious than ever.
Gauze shortage
I'm going to award you the Emeritus Dipshitius award for this post. You know zero about healthcare delivery outside of the shallow talking points you consume from Bernie et al. You don't even know enough to fake it.
I should have known better the day you proclaimed that Mercatus knew Bernie was right so they took their study down out of embarrassment that you were an idiot on this subject. It's not a complete waste though. Our interactions will let others here know how full of shit you Bernie bros are.
Gauze shortage
Utilization is at an all time high. Chronic disease is at an all time high. Here’s an idea, let’s stop treating fat people or people with any other self inflicted malady.
I'm smirking because cutting reimbursement to medicare rates across the board will cut the money other hospitals receive to bid up the price of resources you think are fixed.
Equal outcomes for all, that is what Socialists want. They expect others to accept lower wages and higher taxes and free shit for them as long as it increases their standard of life and does not hurt their pocket book. The irony is, they lower the bar for all. Cher is the perfect example, against Trump on immigration until she realized they can not realistically accept all these illegals. It is like their reality is for everyone but themselves. They have no concept or economic reality of what they are proposing. The level of stupidity is mind boggling. Obama said it took a magic wand to create jobs, I am starting to believe he really believes that. The Dims have no concept of how to run an economy, how to make money, how to create jobs.
Not sure it is worth debating because the American public is not going to jump off this cliff at a time when we have lowest unemployment across all demographics in history.
The Netherlands and the US, what could possibly be different between the two? Alexandria pilt cortez says nothing at all!!!!!
Do you dispute that healthcare inflation has massively outstripped the cpi? Do we really need a source for that? I guess I also need a source to tell you that that healthcare cost index includes medicare and medicaid.
At what cost? You obviously don’t play in this world. You should really take another look at medic’s post. What do you cut? Number of personnel? Reduce quality? No nurses maybe ... only MAs. You don’t understand the way Medicare works, if you believe hospitals have any impact on allowances.
I'm always up for a good discussion until willfully stupid enters the picture. We reached willfully stupid early in this thread, but it needed to be fleshed out in case anyone thought pilt had a clue about the costs of healthcare delivery.
You are dealing with something that is a form of religious fanaticism, there is no reasoning, just blind faith.
Ladies and gentlemen medic rides in an ambulance and therefore knows more about delivering healthcare than all the other countries that manage to do it vastly cheaper than the US. Costs are cost and respond not at all to demand.
Pilt, if you get 3 speeding tickets this month and have 2 at fault wrecks, what is going to happen to your car insurance?
Healthcare is being burdened by an explosion of heart/lung disease and diabetes. Chronic Illnesses that cost more to treat. It’s not a vacuum.
If I actually rode in an ambulance this would be a good dig. I haven't been on an ambulance since 1999. At least I'm not embarrassed to share what I do for a living.
