Yeah, god forbid you can no longer stick people caught in out-of-network situations with giant-ass balance bills!

I mean, not being about to soak sick people for all their money is just goddanm unamerican!

It allows the Insurance companies (you like them?) to dictate the terms of their contracts or non-contracts as they see fit. What's the point of contracting with them in this case?

Here's the problem. For most people who aren't insured thru their employers, the only policy they can get is a very high deductible one. So the "insurer" will almost never have to pay out dime one because the bill will not hit the deductible amount.

So what will happen is that more Emergency departments will close, more hospitals be unable to staff their call panels, and less access to health care for the uninsured/underinsured. We went thru this 10 years or so ago, when all of the orthopods in Clark county dropped off the call schedules at the trauma centers. Since people found the thought of having to be flown to LA or Salt lake for their busted femur not optimal, things were emergently fixed. So we're going to do it again.....

Per a 2016 article in The Atlantic (not exactly a bastion of right-wing politics) -" It isn't that there are fewer emergencies. According to the American Hospital Association, from 1991 to 2010, emergency department visits soared from 88.5 million to 127.2 million. That's an increase of nearly 44 percent. But during this same period, emergency departments closed at a rate of almost 11 percent. We see something similar with trauma centers. Between 1990 and 2005, 339 trauma centers shut their doors." How cutting reimbursement is going to improve things isn't clear to me.

MM MD

Another state effort to create universal coverage, this time by allowing anyone to buy in to medicaid. Any Nevadans can provide more info?
https://www.vox.com/policy-and-polit...dicaid-for-all

Selfishly, I'm in favor - we've gone in the last three years from 40% no pay patients in my ED to much less (due to obamacare and an improving economy) and this would drive the % lower.

But it's not going to solve the access to care problem. At least in Reno, AFAIK there are NO private practice docs taking medicaid at all, primary care or specialty. It would help a couple of the county clinics which would be good, but they get $$ from the state to keep the doors open.

At 81% of medicare, hospitals and doctors offices are losing money on every patient they see, as you don't recover your fixed costs.

MM MD

How must it feel for people, like those in Ohio, to lose their last insurer and then see the POTUS go on TV all excited to score points by announcing how you and 19000 others are screwed because of the Ocare death spiral?

Wouldn't fixed costs only apply if the Medicaid patients were somehow displacing private insurance patients? Or if hospitals had to hire more staff to handle Medicaid patients?

This is healthcare related:


https://twitter.com/speechboy71/stat...64733822136320

The whole idea of expanding coverage is to get the uninsured population into a primary care setting. It's a GOOD idea. It's much cheaper to fix problems early rather than late. The issue is that these are additional patients entering the system - we saw about a 20% bump in Obamacare patients in our ER when it opened up. They paid at Medicare rates or close to it - so that was fine. You can pretty much break even on those patients. (I'm mostly talking about hospitals here)

But if you draw in Medicaid patients to your clinic/ER that weren't previously getting health care, it's a killer. By the time you're done with the fixed cost you lose money on each patient. Enough of a bump in census, you have to add staff - if you don't, your insured players walk out because of wait times. Lose enough, and your ER or hospital closes, as the Atlantic article talks about.

MM MD

We see them.

Some of my colleagues would rather fly to Africa to see indigent patients rather than those in our backyards.

Yeah, we see them too.

It's tougher on the private practice docs - I'm an ER guy, and so even if the reimbursement is small I at least get something (less the small amount (5$ or so) that I have to pay in med mal - so if I'm there anyway, might as well see the patient. For the hospital, it's a different story - they have to pay for staff/equipment/meds/cleaning etc. etc. - and so does a private docs office. For them, medicaid will put you out of business, if you see enough of it.

MM MD

Eric Trump, who just said Democrats aren't really people, is more altruistic?

Yeah, sure, and Ivanka is a moderating influence on the nutjob in chief

why is hobbes putting MM MD at the end of every one of his posts? Bizarre. Still not as bad as the manually typed signatures of certain other forum goers but still....

Happens all the time.

Sent from my brand new, beautiful, big screen smartphone that means a lot to me but nobody else gives a **** about.

Force of habit over 30 years.

If it helps, just imagine MD stands for major douchebag. You'll be happier, and I won't have to change.

MM MD

And thinking about it a bit......

I'd guess 80%+ of my posts are in some way related to medical issues, political and otherwise. Knowing a post is made by a doc may give some bit of insight as to whether or not that poster has some knowledge of that particular topic or is just talking out his ass. (Also, it can act as an indicator that the poster may not have a totally objective take on a particular issue, I suppose - which is probably also a good thing)_

Anyway......

MM MD

I'm having a hard time reconciling the two bolded statements. Is hobbes wrong? Is renodoc talking about something other than medicaid patients when he says "them".

If it's the former, how is it possible that hobbes wouldn't know of one of the very few specialists that takes medicaid? Especially when it happens to be someone he actually knows.

Can one of you guys help me out here?

I think my friend Hobbes is hyperbolizing

And yet he is correct- if we see every medicaid patient at a 5 dollar loss we cant "make it up with volume "

I'm having a hard time reconciling the two bolded statements. Is hobbes wrong? Is renodoc talking about something other than medicaid patients when he says "them".

If it's the former, how is it possible that hobbes wouldn't know of one of the very few specialists that takes medicaid? Especially when it happens to be someone he actually knows.

Can one of you guys help me out here?

To clarify. At least in my community there are no private practice doctors that I know of who see medicaid patients "off the street" - although there may be one or two I'm not aware of. I do know that there are (or at least as of Jan 2016 when I stepped down as COS of our hospital) no OB/gyn doctors, IM docs, orthopedist or GI docs that will schedule a patient who dials up their office with medicaid as their only payer. There are a couple of clinics designed to care for un/underinsured patients who will see medicaid, but they're subsidized by the state/county. Some of them have arrangements for getting consultation for their patients, but I'm not sure exactly about how it works.

A fair number of specialists WILL see a medicaid patient if they're referred from an ER, as they are compensated for caring for medicaid/uninsured patients by the hospital, with the understanding that a follow up office visit will be given.

Renodoc practices (and very ably) is a subspecialty of medicine that I might consult once every couple of years. When he used to take call (sadly for us, he no longer does) he took all comers out of the ED graciously.

WE - meaning my ER group, see all comers. We're mandated to by statute. By EMTALA, any patient with an emergent medical condition who presents to a hospital Emergency Department must receive a medical screening exam/testing and any emergent condition must be stabilized - irregardless of payer status. (Note that this DOES NOT, with a couple of minor exceptions, apply to doctors offices or urgent care facilities.) If I determine that specialty care is needed, I call our on call doc, who is (generally) paid by the hospital to take call, or a hospital employee who as part of their duties sees the patient.


Which I'm more than fine with, BTW. (Referring to the part about seeing all comers)

MM MD

And just to clarify a bit - my original post referred to the problem of getting people primary care - which is a struggle pretty much nationwide. It's all good if someone shows up in my ER in renal failure and needs emergent dialysis - I can make that happen with a couple of phone calls. But it would have been better (and a hell of a lot cheaper) to have a primary care provider manage the patients hypertension or diabetes originally so their kidneys didn't die.

MM MD

Call your Senators guys. They are about to pass this thing right under our noses.


https://twitter.com/sahilkapur/statu...70236368433152

Does this mean they aren't writing their own version? Would be surprised if the house version passed the senate.

Does that mean AHCA's clear to pass under reconciliation?

Interesting.

DIB MD LCSW CEO

This is bad.

http://thehill.com/policy/healthcare...caid-expansion

Key GOP centrists open to ending Medicaid expansion

Portman was someone who I thought would be a big hurdle, and if he's willing to end the Medicaid expansion, then I think there's a decent chance the House and Senate can agree on a repeal bill.