Medicare PartB Payment to Dr Revealed

[unic.consulting]

IF it took them that long to think about it they never saw one of my presentations.

If they realized it then, they realized it.

IF the sign was up and specifically had in bold the same font as the prices that their prices may be as low as nothing depending on insurance or some variation of that it would help achieve the same goal.

Again, consumers don't even think about the cost of healthcare and to me that's a huge problem; how can you value something you don't even see the price on. It's "free", so why does the premium keep going up?

I'm sure there are several people out there who have not seen your (or my) presentation. I definitely make sure my clients understand what they're getting into.

Do you have a sign up stating your commission rate for various products? Do you think that would help consumers value your services better?

 

[Josh]

I'm sure there are several people out there who have not seen your (or my) presentation. I definitely make sure my clients understand what they're getting into.

Do you have a sign up stating your commission rate for various products? Do you think that would help consumers value your services better?

There are a number of differences there. Healthcare is heavily regulated for a number of reasons. You're comparing apples to turnips here because the commission is very different than the fee. Clients know what they're paying before they sign up and have it clearly explained to them. A provider isn't going to have their take home pay as directly related because they actually have overhead that's going to cover like the office, malpractice insurance, the office staff, etc.

You're also talking about some providers very near to each other providing relatively similar levels of service:

In Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000.

In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000.

For example, billing records showed that Keck Hospital of the University of Southern California charged, on average, $123,885, for a major artificial joint replacement, six times the average amount that Medicare reimbursed for the procedure and a rate significantly higher than the average for other Los Angeles area hospitals.

http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?_r=0



We're no talking about one provider charging $100 and another charging $125, we're talking about for ever $100 one provider charges, another charges $200-$500. That's huge.

 

[unic.consulting]

There are a number of differences there. Healthcare is heavily regulated for a number of reasons. You're comparing apples to turnips here because the commission is very different than the fee. Clients know what they're paying before they sign up and have it clearly explained to them. A provider isn't going to have their take home pay as directly related because they actually have overhead that's going to cover like the office, malpractice insurance, the office staff, etc.

You're also talking about some providers very near to each other providing relatively similar levels of service:





http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?_r=0



We're no talking about one provider charging $100 and another charging $125, we're talking about for ever $100 one provider charges, another charges $200-$500. That's huge.

But once again, the random numbers that they throw out at the insurance companies don't match what they actually bring in.

Medicare does not actually pay the amount a hospital charges but instead uses a system of standardized payments to reimburse hospitals for treating specific conditions. Private insurers do not pay the full charge either, but negotiate payments with hospitals for specific treatments. Since many patients are covered by Medicare or have private insurance, they are not directly affected by what hospitals charge.

Experts say it is likely that the people who can afford it least — those with little or no insurance — are getting hit with extremely high hospitals bills that may bear little connection to the cost of treatment.

So again, it's the people without insurance that need to know how much they are being billed ahead of time. Usually they are pretty careful about finding it out.

As insurers demand bigger discounts from a hospital, a facility may raise its charges to protect its bottom line, that official, Caroline Steinberg, said. “The hospital raises its rate to cover the discount,” said Ms. Steinberg, who is the group’s vice president for trends analysis.

So the real "solution" would be to socialize medicine and make a certain procedure cost a certain amount. Otherwise it's all just random junk

 

[Josh]

But once again, the random numbers that they throw out at the insurance companies don't match what they actually bring in.

It's not that random. Carriers do also pay providers differently. The bigger/better groups will command a higher rate than the other guys.

So again, it's the people without insurance that need to know how much they are being billed ahead of time. Usually they are pretty careful about finding it out.

No, I'm referring to everyone. People with insurance should have some idea of what the costs are going into this. Why do you think HMOs and preferred networks exist? Because it's a way of containing costs based on contracts with providers. The PMPM model on HMOs still exists, but even without that having contracted providers that agree to rates helps keep costs down. If insurance companies paid all providers the same there would be much less of an incentive to do that.

So the real "solution" would be to socialize medicine and make a certain procedure cost a certain amount. Otherwise it's all just random junk

You're making up an argument. I'm not advocating socialized healthcare; I'm suggesting folks should have some idea of what the billing side of the cost of their care looks like. The average doctors visit is 8 minutes with a patient. If the sign on the wall listed their charge for a visit consumers might hold providers to a higher standard. Ultimately providers are in business and that's how consumers should view it. Shop on value and price. Consumers should have a deductible and have an idea of what the doctor bills long before they get their EOB. I wouldn't be sad to see the doctors billable vs paid vs patient responsibility in the provider guides for that matter. I doubt that will ever happen and it might not be the solution, but as long as consumers view doctors and providers as healers blessed by Jesus Christ himself and give no thought to what this care is actually costing, we're never going to see providers have to actually treat this like the business most other companies have to deal with by creating value in terms of quality and price vs the god complex many providers have given to them by their patients.

 

[Norwayguy]

Define basic services.

Preventive care is all free now, so no need to post prices there. Even birth control is free. That get's the drug stores off the hook.

Doc. How much is a basic colonoscopy? One where you just look but don't do anything?

OK, how much if we take off the anesthetic?

That much, huh?

That's just it those services are not free its not like provider is not being paid and let's face it the prices are factored into the policy. But it leads the consumer to think his policy is doing less for them than they realize.

----------

IF it took them that long to think about it they never saw one of my presentations.

If they realized it then, they realized it.

IF the sign was up and specifically had in bold the same font as the prices that their prices may be as low as nothing depending on insurance or some variation of that it would help achieve the same goal.

Again, consumers don't even think about the cost of healthcare and to me that's a huge problem; how can you value something you don't even see the price on. It's "free", so why does the premium keep going up?

Totally agree if the consumer listens to Obama they know their annual exam is free but that does not mean there is no cost we know the provider is not taking a hit.

 

[unic.consulting]

I wouldn't be sad to see the doctors billable vs paid vs patient responsibility in the provider guides for that matter. I doubt that will ever happen and it might not be the solution, but as long as consumers view doctors and providers as healers blessed by Jesus Christ himself and give no thought to what this care is actually costing, we're never going to see providers have to actually treat this like the business most other companies have to deal with by creating value in terms of quality and price vs the god complex many providers have given to them by their patients.

Honestly, I think that is a much better option. My main problem with posting it in the doctor's office is the fact that it won't be accurate for any of the patients. If we're talking about one specific plan giving out their rates, I am all for that.

 

[Josh]

Honestly, I think that is a much better option. My main problem with posting it in the doctor's office is the fact that it won't be accurate for any of the patients. If we're talking about one specific plan giving out their rates, I am all for that.

For example, in the provider directory:

Bob Smith - Office charge $350 - with XYZ plan $200, $40 copay.
Robert Thompson - Office Charge $150 - with XYZ plan $150, $40 copay.

I still think it should be a sign in the office. When providers see patients they have no qualms with having them sign contracts saying they're responsible for the charges if the insurance doesn't pay, so why shouldn't they have to have the rates readily available so they know what their liability would be?

 

[unic.consulting]

For example, in the provider directory:

Bob Smith - Office charge $350 - with XYZ plan $200, $40 copay.
Robert Thompson - Office Charge $150 - with XYZ plan $150, $40 copay.

I still think it should be a sign in the office. When providers see patients they have no qualms with having them sign contracts saying they're responsible for the charges if the insurance doesn't pay, so why shouldn't they have to have the rates readily available so they know what their liability would be?

That's a different argument than deciding which doctor to go to due to the usual charge by the doctor. I think that the rates should be available on demand by the patient.

 

[Justin Bilyj]

http://www.nytimes.com/interactive/2014/04/09/health/medicare-doctor-database.html?_r=0

this allows you to see how much your doctor made off Medicare

1% Of US Doctors Account For Over $10 Billion Of Medicare Billings | Zero Hedge

The top 1% of 825,000 individual medical providers accounted for 14% of the $77 billion in medicare billing in 2012, according to new federal data reported by the WSJ. The data shows a very small number of doctors and medical providers account for a huge amount of the costs for treating the elderly and, as WSJ notes, suggest in some cases, may be enriching themselves in the process.