I don't have a good healthcare cost per capita by age graph, but lining that up with this one before age 65 at least is what you'll be doing. Trying to find one

Well ****, can only find one from 2002, idk.

Still not able to find a good graph. I'm just thinking out lout here man, if you're complaining about the current subsidy system being unfair then it kind of matters how you set up your alternative. Healthcare costs really start to rise with that 55-64 age group, so the amount of "young subsidizing the old" depends on how well that matches up with however you choose to judge their ability to pay based on income and wealth. It seems like the 30-40 age group has healthcare costs that are still quite low but their income is beginning to reach its peak levels, so it seems like they'll be the ones still subsidizing the older group through their taxes.

Consensus in industry has been 5 to 7 to 1 for age rating curves for a long time.

As of July 1 I won't get paid for doing an examination of an eye on the same day that I do an injection.

Here's some options:

1) eat the money
2) have the patient come back the next day for a shot
3) come up with some kind of cash "same day injection convenience fee" --I'm researching the legality of this.
4) ????

Its been suggested that I see patients at 10 PM, and start doing injections at midnight.


Its about $80 an exam. I look in the eye to see if there is blood or fluid or whatever and then determine if grandma needs the needle this visit. I use Avastin most of the time, which costs $30. I try to get patients to the point where they don't have to come in every 4-6-8 weeks and get jabbed in the eye. As often as possible I look for a reason NOT to inject the patient.

Some docs use Lucentis ($2000/shot) exclusively (they are the $6 Million men that were published last month) Many of them just do monthly injections and maybe they don't have to actually look at the eye every time.

As a side note- if a patient needs both eyes injected, the second eye pays 50% of the fee if done on the same day. Many of my colleagues already have a model where they won't do bilateral injections because of this.

Literally nothing in what you wrote makes anyone feel bad for you.

You know why there's a bundling relationship between those things right?

And before you whine some more about me calling you a whiner, you seem to be talking about Medicare patients. Obamacare did exactly nothing to materially change Medicare. I don't remember you feverishly posting about flaws with Medicare during the Bush administration.

*This assumes that your information is correct. That's a big assumption.

riverman he says nothing about obamacare in that post. come on now

lol ikes sticking with his buddy.

weird that he would post in the OBAMACARE thread then

You know thank God that, say, implausibilty aside, Bush didn't sign a healthcare reform law. BushCare sounds like it should involve a wax and hair trimming

Right, because various health policies aren't constantly talked about itt. Next time someone brings up single payer I'll shout them down with OBAMACARE ISN'T SINGLE PAYER right?

Come on schu. Be better than that.

LOL ikes, renodoc is a horrifying vision of things to come. Have that degree, have that money, still get laughed at.

I shed a single perfectly formed tear when I read that renodoc cant fleece the system and charge 80 bucks to look in an eye for 30 seconds. At this rate renodoc may make even less than that mid six figures a year that he recently humblebragged about. Woe is he.

I'd like some credit for being way ahead of the 'lol doctors' curve. Holy ****ing **** Reno.

Yeah I was starting to feel bad but I assume the $80 fee includes an exam that last mere moments.

Perhaps it is technically impossible to charge a single fee that covers either/or.

As for the convenience fee it seems history has screwed doctors who have tried to circumvent insurance regulations. I don't mean this in a bad way but insurance companies and regulators will likely not be okay with it.

I remember the ny doctor a while back who basically created a membership for his patients. They pay a reasonable monthly fee and can come in as often as they want. He had to stop because they said he was illegally selling insurance.

What percentage of exams lead to shots? If the percentage is high enough can you get more for the shot ? (I assume no as prices are fixed). In a perfect world you would be able to charge more for the injections and essentially do the exams for free.

Is there some abuse where ophthalmologists are booking exams and injections for clients who already need injections? Ie what is the impetus of this change? I could see doctors doing an exam, saying an injection is needed then scheduling it with a second exam in the future.

Ultimately it is what it is. Have people come back the next day. I manage my parent's healthcare and take them to all their visits. They have the same gp and a few months ago he decided they needed to be seen once a month. This is a meds check and just basic check up. At first I was pretty annoyed by it, but now I am actually fine with it simply because they are seeing the doctor regularly. Can get annoying if they actually get sick though. Not to mention their visits are not synched up.

Seems like a pita but if everyone is in the same point it is what it is. Obviously it sucks for your revenue per visit numbers but them the breaks.

The more I think about it, the more it seems like the change was made because Medicare thinks the exam is part of the injection process. Not an unreasonable position.

Medicare pays out on a cost plus basis for pretty much everything except pharmaceuticals and it is all based on sophisticated modeling involving every aspect of a particular treatment or procedure. Sounds like they felt padding was going on.

Renodoc, would you ever give one of these injections to a patient without examining the eye first?

Its kinda absurd for me to continue posting here

The reimbursement for the injection was about $800 in 1999, $350 in 2006, and is now $106.

I always look at the eye first

I usually use a drug that costs $50 or so, saving medicare $1950.

If i use the $2000 drug, then i get about $80 in "profit" for using it. That would make up for the revenue lost by them bundling the exam into the injection fee.

Maybe i should just do that? I've never given an injection of Lucentis, but i hear they will pay me additional kickbacks and buy me dinner if i do

Or they could just call it Medicare Part D

It is amazing to me that any of the alternatives discussed which increase revenue and provide no benefit to the patient are legal and/or ethical. The unnecessary multiple visits, the unnecessary expensive drug. Amazing to consider those reasonable alternatives. Just because other doctors take the fraud route doesn't make it OK.

If I take my car to the mechanic and he thinks he doesn't make enough money on oil changes, he doesn't get to make up that I need new brakes. That's fraud.

It is simple, obviously several posters aren't interested in debating the substance of your arguments so they make personal attacks. How much more blatant can a rules violation be than posting a picture of a baby crying in response to your post. It is embraced though because they hold the "correct" viewpoints.

cryingbaby.jpg

Effing socialist government screwing the little guy again, conspiring to limit his income to mid six figures. Our collective hearts go out to you.

worldstiniestviolin.jpg

Seriously though, what is it that you would like done from a policy perspective to alleviate this injustice?

First, if i was an auto mechanic and was told that i could look at brakes on monday, but only get paid if i fixed them on tuesday--would i be getting the same "opinion" ITT ?

Personally, ive saved medicare over $60 million by using avastin. And ive "left on the table" a bunch of money also. Instead of a medal, ill likely get an audit.