New M4A Study: Will Save Americans $450 Billion and Prevent 68,000 Unnecessary Deaths

[BOZZ]

Doctors schedule their own bookings and clean their own offices too.

Very few doctors or surgeons that I've seen have even accepted medicare patients, much less wanted everyone to be on it.

The whole post was bull****. The number one complaint I hear is that they're understaffed and overworked. Keep in mind this is with 3-7% of QUALIFIED candidates annually going unmatched. The wait list for med school doesn't matter because they're not going to be desirable candidates anyway.

[NitrogenWidget]

The whole post was bull****. The number one complaint I hear is that they're understaffed and overworked. Keep in mind this is with 3-7% of QUALIFIED candidates annually going unmatched. The wait list for med school doesn't matter because they're not going to be desirable candidates anyway.

yeah, we actually do only want the best and the brightest as DR's.

[StoliFun]

Oh yeah #4? Doctors don't fill out billing information. That's just a ****ing lie

Rflearner was speaking imprecisely there. Paperwork and admin tasks are doctors #1 complaint. Doctors do spend a lot of time filling out paperwork and taking notes to make sure their hospital/clinic/etc gets remunerated by whatever insurance company. And they do a lot of paperwork trying to jump through different insurance companies' hoops to get them to agree to pay for the medicines they think are best for their patients.

[BOZZ]

Rflearner was speaking imprecisely there. Paperwork and admin tasks are doctors #1 complaint. Doctors do spend a lot of time filling out paperwork and taking notes to make sure their hospital/clinic/etc gets remunerated by whatever insurance company. And they do a lot of paperwork trying to jump through different insurance companies' hoops to get them to agree to pay for the medicines they think are best for their patients.

Besides charting and filling out EHRs doctors aren't doing any of the **** you said. It's all common form and a rubber stamp. Even then this affects mostly primary care docs. At hospitals you're typically going to have a scribe or a pgy1 doing this.

[kovalchuk71]

Rflearner was speaking imprecisely there. Paperwork and admin tasks are doctors #1 complaint. Doctors do spend a lot of time filling out paperwork and taking notes to make sure their hospital/clinic/etc gets remunerated by whatever insurance company. And they do a lot of paperwork trying to jump through different insurance companies' hoops to get them to agree to pay for the medicines they think are best for their patients.

But who was EMR/EPIC? Chit is literally all drop down menus and macros these days. No one is writing out full SOAP notes anymore. This isn’t 1985.

[StoliFun]

Besides charting and filling out EHRs doctors aren't doing any of the **** you said. It's all common form and a rubber stamp. Even then this affects mostly primary care docs. At hospitals you're typically going to have a scribe or a pgy1 doing this.

The stats showing physicians complaining about paperwork are skewed by internal medicine, pcps, pediatricians, and emergency medicine butchers who together make up a plurality of practicing physicians in America (your wife's specialty is one of the smallest). Some studies have shown doctors experiencing a 1:2 ratio of time spent interacting with patients vs time dealing with paperwork (https://www.health.harvard.edu/blog/...016103110558):

A recent study published in the Annals of Internal Medicine supports prior research in this area showing that a ridiculous amount of a doctor’s time is spent interfacing with a computer or on other administrative tasks, instead of with patients, even when the patient is right there in the room.

The researchers observed 57 physicians from four different specialties (family practice, internal medicine, cardiology, orthopedics) in four different states for a total of 430 hours. They were interested in learning precisely how doctors spend their time.

What they learned was that during office hours, half the time — a huge chunk — was allocated to desk work, like documentation in the electronic medical record (EMR), reviewing test results, handling medication requests, and filling out forms. What was remarkable was that even during office visits, doctors interacted with their patients for only half of the time; the rest was EMR and paperwork. As a matter of fact, for every hour of face-to-face patient time, another two hours were spent on desk work.

Notably, about 40% of the doctors observed in this study used documentation support, like voice recognition software or medical scribes, and they still got these results. Also notably, none of the primary care doctors had the luxury of documentation support. You can imagine that the family practice and internal medicine docs (like yours truly) spend even more time on desk work.

Long story short, for most doctors, it's a slog filling out paperwork in dealing with a dozen different managed care plans at a time.

But who was EMR/EPIC? Chit is literally all drop down menus and macros these days. No one is writing out full SOAP notes anymore. This isn’t 1985.

While I'd like to tell you things would be different if I'd accepted one of EPIC's job offers fifteen years ago, for a variety of reasons the prophesied efficiency just isn't there yet.

[StoliFun]

No they don't [support Medicare For All]

https://revcycleintelligence.com/new...e-payer-system

January 21, 2020 - The second-largest physician group in the US recently recommended the implementation of a single-payer system or public option to achieve universal coverage.

According to a policy plan released on Monday, the American College of Physicians (ACP) stated that a single-payer system would improve care accessibility and affordability in the US, and the group’s official endorsement of the system marks “a sea change for the medical profession.”

The provider industry has historically opposed the implementation of a single-payer system, including the American Medical Association (AMA). In support of their argument, the stakeholders have cited concerns that the system would reduce reimbursement rates and worsen the doctor-patient relationship.

...

ACP has been open to the implementation of a single-payer system or public option in the past. But the physician group's latest policy plan explicitly states its endorsement of such a system.

“We believe that American health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and under invests in public health; spending too much on administration at the expense of patient care; and fosters barriers to care for and discrimination against vulnerable individuals,” Robert M. McLean, MD, MACP, president of ACP, said in a statement.

And the AMA are almost evenly split on single-payer (https://www.fiercehealthcare.com/pra...single-payer):

At its annual meeting in June [2019], the AMA’s House of Delegates voted to adopt a new policy that boosts its push for universal coverage by improving the Affordable Care Act. The delegates also defeated a motion to remove the AMA’s opposition to a single-payer approach to health system reform, which is currently being debated in Congress and is supported by some Democratic candidates for president. However, that vote was reportedly a close one that divided the membership, with 53% voting to maintain opposition.

So, yes, many doktors do support Medicare 4 All. To say nothing of nurses, economists (including Von Hayek), employers, foreign investors, entrepreneurs, posters like that AF vet in Idaho who can't afford to insure his family, parents of children with asthma, etc.

[SillieBazzillie]

Medicare has trouble sustaining 15% of the population.

Liberal math says Medicare will be fine supporting 100% of the population



The math must run on feelings.

Bro I got some bad newz. What % of medical care do you think that 15% of the population consumes? 15%?

[SillieBazzillie]

No they don't. My wife is a pediatric hem onc and she dreads this. There aren't enough physicians for this to work and everyone knows it. The backlog of people that there is for med school doesn't mean **** because you have people that don't even match at the end of their training. These are doctors ready for pgy1 that can't get work somewhere they want to be for a salary they'll take. Adding more patients at a lower reimbursement rate doesn't mean a thing if hospitals are already tapped out on resources. You're not getting more doctors because it's not in the budget now and it definitely won't be when you're bringing in less money

Oh yeah #4? Doctors don't fill out billing information. That's just a ****ing lie

Bozz, I'm super familiar with the medical field and have a couple of questions regarding your wife.
1. Is she employed by a hospital or does she own her own practice?
2. Does she dispense oncology drugs in a hospital setting or does she use a clinic?
3. Is she seeing as much advancement in biologics and immunotherapy treatments as there are on the adult side?
4. Much love to what your wife does. My brother died at age 6 of leukemia. The good work of people like your wife have flipped the cure rate from single digits in the 70's to 70% plus now.

Tell you wife to jump on this forum and she'll have reps for life from me.

[BOZZ]

https://revcycleintelligence.com/new...e-payer-system



And the AMA are almost evenly split on single-payer (https://www.fiercehealthcare.com/pra...single-payer):



So, yes, many doktors do support Medicare 4 All. To say nothing of nurses, economists (including Von Hayek), employers, foreign investors, entrepreneurs, posters like that AF vet in Idaho who can't afford to insure his family, parents of children with asthma, etc.

MOST doctors that I have talked to and there are a lot of them don't support this. Can you show me where the ACP polled their doctors because to the best of my knowledge that was simply a position piece.

Also the AMA still has the same statements it's had.



Furthermore you ignored everything else i spoke on and Cherry picked one statement

[BOZZ]

Bozz, I'm super familiar with the medical field and have a couple of questions regarding your wife.
1. Is she employed by a hospital or does she own her own practice?
2. Does she dispense oncology drugs in a hospital setting or does she use a clinic?
3. Is she seeing as much advancement in biologics and immunotherapy treatments as there are on the adult side?
4. Much love to what your wife does. My brother died at age 6 of leukemia. The good work of people like your wife have flipped the cure rate from single digits in the 70's to 70% plus now.

Tell you wife to jump on this forum and she'll have reps for life from me.

1.University Hospital
2. She works in a hospital setting on the campus.
3. I'd have to ask her
4. She hates what she does some days and loves it others. Probably why we have an assload of wine on hand at all times.

[SillieBazzillie]

1.University Hospital
2. She works in a hospital setting on the campus.
3. I'd have to ask her
4. She hates what she does some days and loves it others. Probably why we have an assload of wine on hand at all times.

Interesting. Thanks.

[Mark1T]

I agree with BOZZ because my family is in the medical and insurance fields as I have written before here. There are not nearly enough doctors to implement socialized medicine. Healthcare would devolve slowly because the government would have to give much more responsibilities to nurses and PAs, and given that alone, the quality of care will also devolve.

The doctors and nurses I know hate Obamacare and they are dead against Medicare for All. Couple important reasons: Doctor's incomes would be reduced and reimbursement from the government is protracted and discounted and a major pain in the ass. And, yes, paperwork is increased.

I can write more, but busy making money. Bottom line, socialized medicine or Medicare for All in America would be a gigantic cluster-fuk.

[BOZZ]

Interesting. Thanks.

Check your user cp. I'm not trying to give away too many details since she's in a pretty small field

[SillieBazzillie]

Check your user cp. I'm not trying to give away too many details since she's in a pretty small field

Good stuff Bozz.

[StoliFun]

MOST doctors that I have talked to and there are a lot of them don't support this. Can you show me where the ACP polled their doctors because to the best of my knowledge that was simply a position piece.

Also the AMA still has the same statements it's had.

[img]https://i.ibb.co/VV4hdW2/Screenshot-20200218-092814-Chrome.jpg[img]

I didn't see a poll of ACP members, but they've been more open in the past than the AMA to things like UHC and Medicare buy ins. I highly doubt this position piece they came out with flies in the face of the vast majority of its members.

And yes, AMA hasn't changed its position, but I didn't make up that an AMA motion to strike down their position against M4A was only narrowly defeated recently.

All that is to say that there are apparently a lot more doktors who support M4A than you've had the opportunity to talk at.

Furthermore you ignored everything else i spoke on and Cherry picked one statement

For one thing I think a lot can be done by M4A to free up doktors' time to do less administrative BS and more medicine, ameliorating a doctor shortage. For another the impact on availability will be highly regional, and things will take time to redistribute anyway. Dwindling communities, for instance, are typically going to be less served than cities because fewer doctors want to work in sad little towns.

But mostly I didn't address your doctor's shortage because I think denying people universal coverage and choosing instead to ration care based on their ability to pay or the ability for their employer to pay (for insurance) is not morally defensible.

[BOZZ]

I didn't see a poll of ACP members, but they've been more open in the past than the AMA to things like UHC and Medicare buy ins. I highly doubt this position piece they came out with flies in the face of the vast majority of its members.

And yes, AMA hasn't changed its position, but I didn't make up that an AMA motion to strike down their position against M4A was only narrowly defeated recently.

All that is to say that there are apparently a lot more doktors who support M4A than you've had the opportunity to talk at.



For one thing I think a lot can be done by M4A to free up doktors' time to do less administrative BS and more medicine, ameliorating a doctor shortage. For another the impact on availability will be highly regional, and things will take time to redistribute anyway. Dwindling communities, for instance, are typically going to be less served than cities because fewer doctors want to work in sad little towns.

But mostly I didn't address your doctor's shortage because I think denying people universal coverage and choosing instead to ration care based on their ability to pay or the ability for their employer to pay (for insurance) is not morally defensible.

So you're against illegal immigration and abortion too then? Just trying to make sure I understand what is and is not morally defensible.

[Gayford]

Has there ever been an industry that the govt. took over and managed to make more efficient??

Came in to post this.

Have you ever been to the DMV, the Social Security Office or the Post Office?

I would NEVER want to go to a government run hospital or doctor.

These people pushing this are completely delusional. Take that crap somewhere else. I am very happy with both the cost of my current health care and the service I receive.

[Gayford]

But mostly I didn't address your doctor's shortage because I think denying people universal coverage and choosing instead to ration care based on their ability to pay or the ability for their employer to pay (for insurance) is not morally defensible.

I you are morally concerned about the current state of health care fear not, health care is available to everyone right now. If you need care go to one of the clinic or the emergency room.

Looking for a Doctor

If you do not have health insurance, HOPE Clinic has an eligibility process that will put you on a sliding fee scale. You will pay anywhere from $30 to $85 depending on your household income and size. For more information, please give us a call at 713-773-0803. Thank you!

[Gayford]

Rflearner was speaking imprecisely there. Paperwork and admin tasks are doctors #1 complaint. Doctors do spend a lot of time filling out paperwork and taking notes to make sure their hospital/clinic/etc gets remunerated by whatever insurance company. And they do a lot of paperwork trying to jump through different insurance companies' hoops to get them to agree to pay for the medicines they think are best for their patients.

WTF are you talking about, the doctor charts the patient, writes a prescription and or follow recommendations and moves on. The hospital staff handles billings and insurance steps.

Do you think in a Gornvement run environment there would be no paperwork? HAHAHAHAHAHAHAHA have you ever been to any gov office?

[ImBunky]

Is congress going to have the same plan that the rest of us have?

[Mark1T]

Is congress going to have the same plan that the rest of us have?

Congress complained pre-Trump that they had no intention of giving up their private insurance in a slap to Obamacare.

_______________________________

How can anyone be anti-gun and also pro-abortion? Doesn't make sense.

[jlick]

But mostly I didn't address your doctor's shortage because I think denying people universal coverage and choosing instead to ration care based on their ability to pay or the ability for their employer to pay (for insurance) is not morally defensible.

I think you are a little confused here. Medical care is expensive because it takes many years and huge investment to produce high quality doctors. would you be morally ok with reducing the overall quality of medical care?

[SillieBazzillie]

Is congress going to have the same plan that the rest of us have?

I agree with this old phuk.

[DuracellBunny]

Is congress going to have the same plan that the rest of us have?

They are allowed to insider trade.

They have a taxpayer slush fund to pay off sex crime allegations against them.

They can legally be "bribed".

They are not plebians and mundane rules don't apply to them.

[rise21]

Didn’t they make the same or very similar promises about Obamacare?

[katya422]

Came in to post this.

Have you ever been to the DMV, the Social Security Office or the Post Office?

I would NEVER want to go to a government run hospital or doctor.

These people pushing this are completely delusional. Take that crap somewhere else. I am very happy with both the cost of my current health care and the service I receive.

Single payer doesn't equate to "a government run hospital or doctor". I believe a lot of countries work that way (NHS?), but it can be private for profit and non-profit providers that are reimbursed by a single agency/payer vs. multiple agencies. It also doesn't necessarily have to equate to zero cost at the point of service and could include co-payments and a max out of pocket.

I you are morally concerned about the current state of health care fear not, health care is available to everyone right now. If you need care go to one of the clinic or the emergency room.

Looking for a Doctor

If you do not have health insurance, HOPE Clinic has an eligibility process that will put you on a sliding fee scale. You will pay anywhere from $30 to $85 depending on your household income and size. For more information, please give us a call at 713-773-0803. Thank you!

The emergency room is only required to stabilize you (prevent impending death), not to treat ongoing chronic conditions. So if you are in diabetic shock that should be treated, but if you need ongoing insulin supplies they don't do that.

Reduced fee clinics and hospitals are better than nothing. Still they don't help everyone. You have to show proof of income and in some cases there is a look back period which means that people may meet the qualification now, but if they made too much money last year then they don't qualify for treatment.

And that isn't even addressing the fact that often the people that are the most ill are unable to work and therefore don't have insurance and prompt access to care:

James Barton, 50 years of Software Development, IT Architecture, and R&D.
Updated Feb 9

When my son was 39 he had to leave his job because he had trouble standing for a long period, a requirement of the job, due to what he thought was a hernia. He had hoped to work there long enough to get insurance and have the hernia fixed. But he had not yet gotten his ninety days so he was uninsured.

He started applying for jobs but could not continue in his line of work as a head-waiter or sous-chef because he could not stand for long. After a few months with no luck but a lot of pain, he decided to go to the emergency room. They discovered that it was renal (kidney) cancer and was marginally metastasized.

He did not want us to worry or exhaust our life savings so he contacted a county agent to sign up for Medicaid. It took a few weeks and then he was able to get further treatment for his cancer. By then it had begun to spread to his brain, pancreas, and lungs.

He was able to get chemotherapy, which delayed the inevitable. He also signed up for a test study involving immune therapy but by the time he qualified he was already only three days from death. He died at 40 years of age.

Here's the problem…

Cancer (for instance) makes people very tired and sickly, yet early-on it is very often misdiagnosed, so they can no longer work and they lose their insurance.

- They cannot afford to buy insurance while unemployed, even if they qualify for Cobra.

- They cannot get treatment without diagnosis, yet they can't get diagnosed because they have no insurance.

- They can get emergency treatment, but only after the disease has advanced, possibly even metastasized, but by then it's too late.

I had a friend who had almost exactly the same thing happen to him. After exhausting their life savings he left his wife severely in debt due to the medical bills and his inability to work. Eventually she had to declare bankruptcy and give up a lot of her belongings. In fact medical debt is the main reason for bankruptcies in the USA.

Yes, unfortunately this is common.

Uniquely, in the USA we have a very rare kind of Christianity… (Not all people are this way, mind you, but certainly a lot of them. And this does indeed seem to be unique to people who call themselves evangelical Christians here.) These are people who claim to be compassionate and kind, yet their attitude about amending such problems is, “I’m not paying for somebody else’s medical care.” Yes, really.

https://www.quora.com/Are-people-exa...mes-Barton-129

WTF are you talking about, the doctor charts the patient, writes a prescription and or follow recommendations and moves on. The hospital staff handles billings and insurance steps.

Do you think in a Gornvement run environment there would be no paperwork? HAHAHAHAHAHAHAHA have you ever been to any gov office?

I don't think anyone believes that. The idea is that there would be one standard claim form/claims process instead of multiple forms and varying levels of coverage. Your doctor theoretically wouldn't be burning time making sure that your diagnosis code meets the coverage requirements for your specific insurance or that the drugs they prescribe are included in your plans formulary.

[FatBallz]

Single payer doesn't equate to "a government run hospital or doctor". I believe a lot of countries work that way (NHS?), but it can be private for profit and non-profit providers that are reimbursed by a single agency/payer vs. multiple agencies. It also doesn't necessarily have to equate to zero cost at the point of service and could include co-payments and a max out of pocket.

This is what it's like in Finland. You can use for profit providers and the government will pay a certain amount and the patient has to pay the difference, so the option is always available. They also have private insurance as well for those who want it.

[ImBunky]

I don't think anyone believes that. The idea is that there would be one standard claim form/claims process instead of multiple forms and varying levels of coverage. Your doctor theoretically wouldn't be burning time making sure that your diagnosis code meets the coverage requirements for your specific insurance or that the drugs they prescribe are included in your plans formulary.

I think the idea that with computer systems and one coding system for private insurers (yes a second one for Medicare) the idea that doctors are burning a bunch of time with this is ridiculous.

Hmm, if you were running a business would you rather spend a little more time (if even the case) or take 40% - 60% less for you services? No wonder many doctors are eliminating, or reducing the number of, Medicare patients.

[StoliFun]

Didn’t they make the same or very similar promises about Obamacare?

No.