A hospital fee, minus the hospital

Quote from SigX : you need to learn to approach people with a better attitude and not be so accusitory. If you had any sense you would know that kickbacks are 100% illegal. So no, I have not recieved any payments AT ALL from any pharmacy company EVER. I have eaten at a few free lunches. if you want to rant and rave about some pizza and burgers go for it.

hahaha, what? Then what was the point of the Physician Payments Sunshine Act? Oh right, to make it easier for consumers to see if their physician is getting money from Big Pharma. Maybe it isn't exactly a kickback per se, but I think people will be shocked at the amount of money Big Pharma throws towards doctors and hospitals. If your doctor was getting thousands of dollars from a single pharmaceutical company each year, wouldn't that make you wonder about their prescribing habits?


As to the government waste, all I see you doing is complaining. Is there really a problem? Have you found more articles on this and more data verifying it?

What is the solution? Have you started one of those White House petitions? What about a form letter people can email/fax to their member of Congress? Anything? Rabble rousing on the internet is great, but calling people out and saying we don't care about government waste is hilarious when as far as I can tell you've done nothing to help fix the problem.

Quote from travathian : hahaha, what? Then what was the point of the Physician Payments Sunshine Act? Oh right, to make it easier for consumers to see if their physician is getting money from Big Pharma. Maybe it isn't exactly a kickback per se, but I think people will be shocked at the amount of money Big Pharma throws towards doctors and hospitals. If your doctor was getting thousands of dollars from a single pharmaceutical company each year, wouldn't that make you wonder about their prescribing habits?

You need to man up and stop acting like a goon. your taking part is a discussion when you have no farking clue what your talking about. kickbacks be illegal bro, welcome to the 1990's. this ain't nothing new. Yes, big pharma can hire a doc as a consultant or to give lectures. so can any other industry. as I said above.... I don't do that. #1 I am not a big researcher (which are usually the peeps that do this) and #2 its a bit unsettling to me. but since you all you want to do is attack me, I doubt you believe any of that anyway.

Quote : As to the government waste, all I see you doing is complaining. Is there really a problem? Have you found more articles on this and more data verifying it? What is the solution? Have you started one of those White House petitions? What about a form letter people can email/fax to their member of Congress? Anything? Rabble rousing on the internet is great, but calling people out and saying we don't care about government waste is hilarious when as far as I can tell you've done nothing to help fix the problem.

sorry if I don't meet you expectations as a leader for change. if you don't like it, stay out of my "rabble rousing" treads. do you do anything but complain and make accusations?

Good topic of discussion. It's ridiculous for hospitals to charge more for the EXACT same thing as a private outpatient practice.

Here's another good article on the issue:

Same Doctor Visit, Double the Cost
[wsj.com]

Quote : Insurers Say Rates Can Surge After Hospitals Buy Private Physician Practices; Medicare Spending Rises, Too After David Hubbard underwent a routine echocardiogram at his cardiologist's office last year, he was surprised to learn that the heart scan cost his insurer $1,605. That was more than four times the $373 it paid when the 61-year-old optometrist from Reno, Nev., had the same procedure at the same office just six months earlier. "Nothing had changed, it was the same equipment, the same room," said Dr. Hubbard, who has a high-deductible health plan and had to pay about $1,000 of the larger bill out of his own pocket. "I was very upset." But something had changed: his cardiologist's practice had been bought by Renown Health, a local hospital system. Dr. Hubbard was caught up in a structural shift that is sweeping through health care in the U.S.—hospitals are increasingly acquiring private physician practices. Hospitals say the acquisitions will make health care more efficient. But the phenomenon, in some cases, also is having another effect: higher prices. As physicians are subsumed into hospital systems, they can get paid for services at the systems' rates, which are typically more generous than what insurers pay independent doctors. What's more, some services that physicians previously performed at independent facilities, such as imaging scans, may start to be billed as hospital outpatient procedures, sometimes more than doubling the cost.

Quote from travathian : hahaha, what? Then what was the point of the Physician Payments Sunshine Act? Oh right, to make it easier for consumers to see if their physician is getting money from Big Pharma. Maybe it isn't exactly a kickback per se, but I think people will be shocked at the amount of money Big Pharma throws towards doctors and hospitals. If your doctor was getting thousands of dollars from a single pharmaceutical company each year, wouldn't that make you wonder about their prescribing habits? As to the government waste, all I see you doing is complaining. Is there really a problem? Have you found more articles on this and more data verifying it? What is the solution? Have you started one of those White House petitions? What about a form letter people can email/fax to their member of Congress? Anything? Rabble rousing on the internet is great, but calling people out and saying we don't care about government waste is hilarious when as far as I can tell you've done nothing to help fix the problem.

SigX, this is sadly the kind of trash that I had to see when I did ER call. Can you imagine having travathian as a patient.

Look at his last 200 posts (yes, I read through them). He's an acerbic troll that makes Andy Rooney look like Mr. Rodgers. I don't think I saw a single complement or thank you in any of those posts. And each one is a response where he talks down to people as if he is an authority in that field and others are clueless. He comes into this thread making accusations about physicians getting "kickbacks" - confusing it with honorariums for presenting for a pharmacology talk. I guess he would be OK with having an auto mechanic presenting something on Januvia instead of physcians since there would be no conflict of interest

Quote from SigX : sorry if I don't meet you expectations as a leader for change. if you don't like it, stay out of my "rabble rousing" treads. do you do anything but complain and make accusations?

Here you go champ . . .

Quote from SigX : why are we supporting these large hospital run ACO's with extra payments with no real benefits?

Because people like you sit around complaining instead of doing. You started a thread, posed a question, there's your answer. Because the why of how it occurred doesn't matter at this point. Fixing it should be. And I am pretty sure everyone can agree that one doc shouldn't make more than another for the same thing. You have no desire to try and change it, and there is pretty much no debate to be had regarding if it is wasteful. So why even make a thread? . . . hence rabble rousing.

Quote from paradoxum : SigX, this is sadly the kind of trash that I had to see when I did ER call. Can you imagine having travathian as a patient.

Sadly you're the kind of trash doctor with a god complex.

Quote : Look at his last 200 posts (yes, I read through them).

Sweet, my own personal stalker.

Quote : I guess he would be OK with having an auto mechanic presenting something on Januvia instead of physcians since there would be no conflict of interest

Oh look, another doc on Big Pharma payroll or who gets gifts from them, and who thinks they aren't biased by such things. You can play the with language all you want, but if you are getting something from them, and your prescribing habits change because of it, it is not in the patient's interest and in most cases costs more in healthcare dollars. Hence the upcoming changes in transparency, to make it easier for patients to see if Big Pharma is pimping you like a $20 whore.

No, I wouldn't want an auto mechanic presenting on Januvia, did you graduate from the school of moronic examples? What I also don't want is a Merck funded stooge in charge of optimizing my diabetes regimen. Studies have shown that doctors totally believe they aren't biased, when in fact they are.

Quote from travathian : Here you go champ . . . Because people like you sit around complaining instead of doing. You started a thread, posed a question, there's your answer. Because the why of how it occurred doesn't matter at this point. Fixing it should be. And I am pretty sure everyone can agree that one doc shouldn't make more than another for the same thing. You have no desire to try and change it, and there is pretty much no debate to be had regarding if it is wasteful. So why even make a thread? . . . hence rabble rousing. Sadly you're the kind of trash doctor with a god complex. Sweet, my own personal stalker. Oh look, another doc on Big Pharma payroll or who gets gifts from them, and who thinks they aren't biased by such things. You can play the with language all you want, but if you are getting something from them, and your prescribing habits change because of it, it is not in the patient's interest and in most cases costs more in healthcare dollars. Hence the upcoming changes in transparency, to make it easier for patients to see if Big Pharma is pimping you like a $20 whore. No, I wouldn't want an auto mechanic presenting on Januvia, did you graduate from the school of moronic examples? What I also don't want is a Merck funded stooge in charge of optimizing my diabetes regimen. Studies have shown that doctors totally believe they aren't biased, when in fact they are.

Oh you're too funny. You get mad at SigX for trying to start a discussion with people on the forums about an upcoming problem. If anything you should get mad at me for telling him to just give up for trying to fight what appears to be a losing battle.

God complex...hmm, yeah, um, well yes...that's why I saw nothing but Medical and cash patients for 3 years when I could have been working at Cedars making bank. You got me pegged spot on. Yep, can't argue with that...douche.

If you had even one iota of knowledge with respects to the financial incentives that pharma could give physcians (or any health provider for that matter) you would know your talking out of your ass. 20 years ago maybe. Now we aren't even allowed to get pens since they're valued at over $1. I used to go to those conventions when I was in medical school and pick up those pens and nick-nacks for use when I was on rotations. Now the reps don't even bother coming to your office since they directly market to the public. You're more likely to find financial incentives at play at your local auto mechanic than you are at your physicians office. In CA the reps can't even buy the office staff lunch now. Did you really think that 18 year old MA was pushing hard for Lipitor?

To date I have not received a single penny from any pharma company.

So what kind of stooge do you want talking for Merck? A janitor? A teacher? A physicist? A stripper?

We have weekly CME meetings at our hospital where the specialists get to present the latest studies on updated treatments and new guidelines. There are no pharma reps there. Nobody is paid to make presentations. We have monthly tumor board meetings where we talk about cancer cases and review the path that the disease processed progressed into. Sometimes even the drugs the patient was put on are discussed? Is that biased for you? So talking about the drugs and procedures that we use daily is now wrong? Maybe we should just grunt and throw poop at each other? Studies show... somehow I doubt you could understand a study.

There are physicians who do run around touting the benefits of one drug over another. The do weekly and sometimes even daily lectures and are paid handsomely by pharma. You'll find these physicians to be less and less common. The pulmonologist I rotated with for a couple of years did this. Did he have bias, fark yeah...he's human. He was also pastor at his church and served in the army. You calling him a stooge? He stopped doing the talks since the company markets directly on TV now. Pretty much the only "pharma" reps I see that have physician "stooges" are the orthopedic ones. Guess a $40k knee sale warrants prostitution....

My parents come from a 3rd world country...you know one where the people are all dirty and unenlightened unlike thyself. If you want to live in a country that doesn't use drugs please feel free to get thy ass out of here and move there. If you ever cared to read any of my length rants you would know that I'm most certainly not a shill for pharma. I don't even have an office now because I got tired of the pain management/fibromyalgias coming to my office and got sick of writing all those scripts. I only do hospitalist work now and if you see that as a stooge for big pharma then....well...good luck to ya.

When you start to lecture SigX and myself on how to treat patients without mentioning one bit about how you work with the general public or how you volunteer your time to take care of people you come off as very disingenuous.

I don't agree at all with some of the posters on this board but I rarely find reason to attack them personally. You, on the other hand, seem to revel in stirring the pot. Change your internet demeanor or please GTFO of the podium.... maybe go to a Justin Beiber chat room and go off the teeny boppers.

Quote from travathian : Here you go champ . . .

do you ever engage in conversation without being a jerk?

Quote : Because people like you sit around complaining instead of doing. You started a thread, posed a question, there's your answer. Because the why of how it occurred doesn't matter at this point. Fixing it should be. And I am pretty sure everyone can agree that one doc shouldn't make more than another for the same thing. You have no desire to try and change it, and there is pretty much no debate to be had regarding if it is wasteful. So why even make a thread? . . . hence rabble rousing.

part of the process of change is educating people on the problems. 2 articles have been posted in this thread now explaining the problems and from some of the posts above, many people where not aware of this issue. its called raising awareness.

If you were not so interested in attacking me, you might realize that I am not a hospital employed doc (i.e. I don't cost patients/society/medicare all those extra dollars). I don't expect any praise from you on that issue, I will settle for another baseless personal attack...

Quote : Sadly you're the kind of trash doctor with a god complex. Sweet, my own personal stalker. Oh look, another doc on Big Pharma payroll or who gets gifts from them, and who thinks they aren't biased by such things. You can play the with language all you want, but if you are getting something from them, and your prescribing habits change because of it, it is not in the patient's interest and in most cases costs more in healthcare dollars. Hence the upcoming changes in transparency, to make it easier for patients to see if Big Pharma is pimping you like a $20 whore. No, I wouldn't want an auto mechanic presenting on Januvia, did you graduate from the school of moronic examples? What I also don't want is a Merck funded stooge in charge of optimizing my diabetes regimen. Studies have shown that doctors totally believe they aren't biased, when in fact they are.

one personal attack after the next.... amazing. Certainly you must realize that even IF you were correct in a given debate, nobody wound join your way of thinking with this kind of behavior.

I'll just leave this here...

http://articles.latimes.com/2012/...s-20120527

Quote : A Long Beach hospital charged Jo Ann Snyder $6,707 for a CT scan of her abdomen and pelvis after colon surgery. But because she had health insurance with Blue Shield of California, her share was much less: $2,336. Then Snyder tripped across one of the little-known secrets of healthcare: If she hadn't used her insurance, her bill would have been even lower, just $1,054.

Quote : Unknown to most consumers, many hospitals and physicians offer steep discounts for cash-paying patients regardless of income. But there's a catch: Typically you can get the lowest price only if you don't use your health insurance.

Quote : Hospital executives say they don't like to charge insured patients more, but say that's a result of the country's broken healthcare system.

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(Page 2 of 2)
Many hospitals, doctors offer cash discount for medical bills
HEALTHCARE’S HIGH COST The lowest price is usually available only if patients don't use their health insurance. In one case, blood tests that cost an insured patient $415 would have been $95 in cash.
May 27, 2012|By Chad Terhune

In the view of Robert Berenson, a senior fellow at the Urban Institute and vice chairman of the Medicare Payment Advisory Commission, big hospitals are exerting their market power to charge ever-increasing rates and major insurers go along with it because they can pass along the costs to employers and consumers. Insurance industry officials say that health plans negotiate the lowest prices they can, but that they also need to include prominent hospitals favored by customers in the network, and those institutions can command higher prices.

Hospital executives say they don't like to charge insured patients more, but say that's a result of the country's broken healthcare system.


At Long Beach Memorial Medical Center, where Snyder got her CT scan, the hospital's chief financial officer said insured patients like her pay more to subsidize the uncompensated care given to the uninsured and low reimbursements for Medicaid patients.

Quote : "We end up being forced to charge a premium to health plans to make the books balance," said John Bishop, the hospital's finance chief. "It's a backdoor tax on employers and consumers." Those higher prices charged by hospitals and other medical providers drove up healthcare spending at double the rate of inflation during the recession even as patients used less medical care, according to a new study by the Health Care Cost Institute

Quote from 808Lurker : I'll just leave this here...

what's your point? the cash price was intended for people who don't have insurance but are not poor enough to qualify for Medicaid (or old enough for medicare). it should not be surprising that some places offer this "discounted" pricing.

what they fail to tell you is that the same imaging would have even been cheaper at an outpatient non-hospital affiliated imaging center... but, what's the point, apparently not too many people give a hoot about government waste.

Quote from paradoxum : To date I have not received a single penny from any pharma company.

A friend is a nurse in an infusion lab at UCSD and regularly goes to drug dinners at really fancy restaurants.

I was under the impression that they are also attended by docs. Is that not so?

Quote from 124nic8 : A friend is a nurse in an infusion lab at UCSD and regularly goes to drug dinners at really fancy restaurants. I was under the impression that they are also attended by docs. Is that not so?

This was the case back in the 90's and maybe early 00's. When I was a medical student I would go to these things mainly because it ended up being more of a social event and when were going to ever get a chance to go to fancy dinners when in over $150k in debt.

The average show at one of these events would be about 5 docs (mostly older single men)... I've seen as few as 2 (one time just me and some ancient FP doc) and sometimes as many as 20.

In fact one of the most expensive meals I've ever had was at a Mortons (the first and only time I've ever been to one - yeah I live pretty cheap... no dinners at the clubhouse). I went with 5 other medical students and 2 residents. Total bill for us 7 and the 2 reps was like $600 (don't laugh, to me that's pricey). I wonder how that would be considered whoring though since only one of us has a state license (the 2nd year resident) so the rest of us were leeches.

Most docs never care to go to those because it takes about 3-4 hours of your evening and honestly you usually want to fall asleep after the meal. If you're married you could take your spouse but you would need to get a babysitter and your spouse would be bored out of their mind. So 4 hours of your life for what amounts to $50 meal (sometimes $15 in booze). Comes back to the old single men - no doc in their 30s/40s/50s is going to go to these things.

In the last 10 years these events have really dried up and the last one I went to was in 2007 (mostly to catch up with residency classmates).

On SD you'll find all kinds of people who value freebies over their own time (like those people camping outside BB for a week for a $200 TV). Sadly some docs find these "free" dinners fun and it's their only social interaction outside their practice.

There were a few drug reps that would get way too personal with the docs. I remember this hottie Merck rep who one of our FP preceptors convinced her to get her boobs done and she did just for him lol. Those reps would take those docs 1 on 1 to nice restaurants and get them perks and tickets to games and such. That's all in the past (to my knowledge) since it's illegal. Yes the doc would whore themselves to prescribing the rep's drug. These docs were rare though. Out of the 100 or so I rotated with probably 2 of them were like this. The main 2 docs I trained under actually hated reps coming to the office since it slowed down the staff (they would take long lunches with all the delivery lunches) and would waste precious face time for the doc.

The nicest rep dinner I have gone to still has been my wife's orthodontic meeting at a night club. Pretty sure it was at least $300/head. But 2 hours in I was wanting to stab my hand with a fork to stay awake through the conversation about orthodontic brackets.

Infusion labs are money factories and you will probably see some rep funding parties left and right to keep the sales going.

I was actually considering becoming a drug rep before going to med-school (I already got accepted at that point). I met the CEO of KOS pharmaceutical which was one of companies I was doing a drug trial for. I would have had an initial starting salary of $140k and my own company car (BMW). The company got bought out by Abbot 5 years later so don't know where I would have been, but I would have missed doing nightly rectals and being $200k in debt

Unless a rep is willing to let me bring 2 of my 3 babies and my wife to dinner I'm not even interested in going to those things. I'm sure some don't mind going out to dinner with a hot drug rep at a nice restaurant (this would be the ortho and anesthesia guys - always buff, well groomed and single at every hospital I've been to - almost like they all have to be jocks in HS. Even my wife was going on about how cute the anesthesiologist was when she had the baby last month...digressing)... guess I'm just past that stuff now.

Quote from 124nic8 : A friend is a nurse in an infusion lab at UCSD and regularly goes to drug dinners at really fancy restaurants. I was under the impression that they are also attended by docs. Is that not so?

first off, the rep "freebies" have dried up. the fed gov has stated that the most a rep can give a doc is a meal or an "educational" book and the value can never exceed $100 for one gift/event. secondly, only health professionals count, so you cant bring the wife/gfriend/husband to the event unless they are an MD/nurse etc. etc. Lastly, is this really that offensive? every other business in the nation allows one business to wine and dine the other... my uncle is a salesman and he takes out his connections to dinners all the time..... and look at the perks our politicians receive from industry.... anyone care for a nice 0% interest mortgage from FM???

but lets focus on a free lunch or dinner that the average doc goes to once a year. and of course, this TOTALLY validates government waste.

Quote from paradoxum : This was the case back in the 90's and maybe early 00's. When I was a medical student I would go to these things mainly because it ended up being more of a social event and when were going to ever get a chance to go to fancy dinners when in over $150k in debt. The average show at one of these events would be about 5 docs (mostly older single men)... I've seen as few as 2 (one time just me and some ancient FP doc) and sometimes as many as 20. In fact one of the most expensive meals I've ever had was at a Mortons (the first and only time I've ever been to one - yeah I live pretty cheap... no dinners at the clubhouse). I went with 5 other medical students and 2 residents. Total bill for us 7 and the 2 reps was like $600 (don't laugh, to me that's pricey). I wonder how that would be considered whoring though since only one of us has a state license (the 2nd year resident) so the rest of us were leeches. Most docs never care to go to those because it takes about 3-4 hours of your evening and honestly you usually want to fall asleep after the meal. If you're married you could take your spouse but you would need to get a babysitter and your spouse would be bored out of their mind. So 4 hours of your life for what amounts to $50 meal (sometimes $15 in booze). Comes back to the old single men - no doc in their 30s/40s/50s is going to go to these things. In the last 10 years these events have really dried up and the last one I went to was in 2007 (mostly to catch up with residency classmates). On SD you'll find all kinds of people who value freebies over their own time (like those people camping outside BB for a week for a $200 TV). Sadly some docs find these "free" dinners fun and it's their only social interaction outside their practice. There were a few drug reps that would get way too personal with the docs. I remember this hottie Merck rep who one of our FP preceptors convinced her to get her boobs done and she did just for him lol. Those reps would take those docs 1 on 1 to nice restaurants and get them perks and tickets to games and such. That's all in the past (to my knowledge) since it's illegal. Yes the doc would whore themselves to prescribing the rep's drug. These docs were rare though. Out of the 100 or so I rotated with probably 2 of them were like this. The main 2 docs I trained under actually hated reps coming to the office since it slowed down the staff (they would take long lunches with all the delivery lunches) and would waste precious face time for the doc. The nicest rep dinner I have gone to still has been my wife's orthodontic meeting at a night club. Pretty sure it was at least $300/head. But 2 hours in I was wanting to stab my hand with a fork to stay awake through the conversation about orthodontic brackets. Infusion labs are money factories and you will probably see some rep funding parties left and right to keep the sales going. I was actually considering becoming a drug rep before going to med-school (I already got accepted at that point). I met the CEO of KOS pharmaceutical which was one of companies I was doing a drug trial for. I would have had an initial starting salary of $140k and my own company car (BMW). The company got bought out by Abbot 5 years later so don't know where I would have been, but I would have missed doing nightly rectals and being $200k in debt Unless a rep is willing to let me bring 2 of my 3 babies and my wife to dinner I'm not even interested in going to those things. I'm sure some don't mind going out to dinner with a hot drug rep at a nice restaurant (this would be the ortho and anesthesia guys - always buff, well groomed and single at every hospital I've been to - almost like they all have to be jocks in HS. Even my wife was going on about how cute the anesthesiologist was when she had the baby last month...digressing)... guess I'm just past that stuff now.

the constant demonization of doctors on this site is amazing. who knew we are demon spawn?

Quote from SigX : Take a look around the net at PQRI and incentives for using an EMR system... yet another gov failure. but lets just ignore all these gov failures and blame doctors.

How are incentives for using an EMR system a failure? I'm not really familiar with PQRI, but my wife wouldn't even consider working at a practice without an established EMR.

Quote from SigX : first off, the rep "freebies" have dried up. the fed gov has stated that the most a rep can give a doc is a meal or an "educational" book and the value can never exceed $100 for one gift/event.

Maybe compared to what they used to be, but a $100 meal per week is nothing to sneeze at.

Quote : secondly, only health professionals count, so you cant bring the wife/gfriend/husband to the event unless they are an MD/nurse etc. etc. Lastly, is this really that offensive? every other business in the nation allows one business to wine and dine the other... my uncle is a salesman and he takes out his connections to dinners all the time..... and look at the perks our politicians receive from industry.... anyone care for a nice 0% interest mortgage from FM???

Kinda different when you are being "bribed" to "recommend" their product to someone else, when that someone else depends on your objectivity.

Quote : but lets focus on a free lunch or dinner that the average doc goes to once a year. and of course, this TOTALLY validates government waste.

Strawman. Of course we can focus on both.

Quote : the constant demonization of doctors on this site is amazing. who knew we are demon spawn?

I'm certainly not "demonizing" docs. Just pointing out conflicts of interest. My sister is doc, and she also claims that she is not influenced by Pharma freebies.

But they only do it cause it's good for their business.