A hospital fee, minus the hospital
 

Link. [bostonglobe.com]

I am posting this as an example of why hospitals purchasing or hiring Physician practices is very bad. i am certain people here will claim this is some kind of "failure of capitalism" bs, but i ask you to consider the opposite.... this is another failure of government regulation and laws. its easy to say that the facility fee should just be made illegal, but the problem is that medicare (CMS) WILLINGLY pays more to a hospital based doctor than a non-hospital based doctor... yes, you read that correctly. this is pushing physicians and hospitals to both want to work together and its costing everyone more money (with no real benefit to the patient or system). Whats worse is that the upcoming ACO's are accellerating these relationships. this is the opposite of free market capitalism as there is no incentive for the physician to compete against the hospital or other docs (with a lower cost alternative), in fact its the exact opposite.. manipulated market forces are pushing the 2 to merge as it is more profitable for both to do so. ultimately these systems get so large that there is no real local competition.

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

SigX, just forget trying to educate people on American healthcare. I think it's a losing battle. I'm sure you've been on Sermo and read the last post about possibly unionizing so CMS can't bully us.

There's probably less than 0.2% percent of voting Americans that know what an ACO is. You're can't expect them to know what bundling and the deprivatization of physicians will result in. Only when the shit hits the fan will people wake up.

I'm good for the next 30 years while I still have my mental faculties I can take of my family and friends, but sadly I fear what medicine will be like in 30 years when I need help.

Like many on Sermo I'm moving on to another career and enjoying my family, just trying to forget the cluster that modern day medicine has become. Ignorance is bliss :rolleyes:

yeah, i saw this on sermo as well. wanted to see what people would say here. I cant leave medicine (even if i wanted too) my student and business loans have me still in the hole. gonna have to work 60-70 hour weeks for about 5 years to get anywhere with those loans. hoping my income does not drop by too much in the next 5 years (wishfull thinking, i know).

Just be glad that the AMA has blocked any effort to promote mass immigration of Doctors from India with H1-B visas, like has been done to keep the salaries of engineers down.

Really helps that medicine is a human interaction profession, too.

What do private insurers pay to those same doctors and facilities when the same work is performed?

training in india is far inferior or so the indian docs i know claim.

i am not entirely sure to be honest. i know that my practice has to negotiate yearly for some services but i think that some are just "multiples" of medicare.

anyway, would love to hear your opinion of the article and paying hospitals (purposefully) more for the same services. so you support this?

i have a better answer. i know the COO of a local hospital. Only medicare (not sure about medicaid, did not ask) gives the facility fee (which jacks up the cost). private insurance negotiates a total fee per visit based on coding (pay more for the visit but no facility fee). She had the same opinion as me... shocked that the gov has continues to allow this. :lol:

Sorry man, the healthcare industry knew this was coming and that the current model was unsustainable. Instead of coming together and coming up with a solution they kept lobbying for more bailouts.

It was only a matter of time before the government had to step in, and it's gonna suck, but I don't have much sympathy anymore.

so we're adding more people to the healthcare rolls while at the same time decreasing incentives to become a Dr. and/or remain in the profession.

So does this mean they can't take Wednesdays off every week to golf anymore? ;)

One big change I have noticed in the last 30 years is that when I was a kid I always went to the Dr's and saw the Dr. He/She would take my blood pressure, my heart rate, make me stick my tongue out and say "ahhhhhhh", etc.. These days all that stuff is handled by a nurse (of some sort) and then the Dr. comes in. Heck, even some times I don't even see a Dr. and are prescribed medications.

On one hand I can see why meeting with a Dr. is better but I would say that 90% of the time I go to the doctor it's for some simple reason that someone with considerably less training can handle. You don't need to go to school for 8 years for example to tell me that I have the friggin flu that everyone else has. Personally, I'm for continuing that practice. There are definitely places where a highly trained doctor is necessary but at the same time there are other places where they are overkill. I think a nice balance between the two is needed.

Let me just say, Medicare was near it's end, they needed to start cutting costs. The problem is they kept cutting reimbursements and every year congress would cut an additional bill to keep them the same. The system is broken and has been, it needs to change.

Instead of leading the charge for meaningful reform that would increase incentives for doctors and result in cost savings that could make the program last. The healthcare industry has done nothing to help itself, they just keep lobbying and whining for more "exclusivity", less intervention, more tax payer money and screwing anyone they can. Healthcare in this country is broken, either help with the solution or GTFO.

Heck if enough doctors quit, maybe that will be enough incentive to open up more visa's and then the healthcare industry gets to see what's its like to have their job outsourced like more of this country has.

FYI This is the same stance I take with california unions (and a bunch of other ones), you know the system is broken, by whining and ignoring the problem you take yourself out of being part of the solution, and it sucks when you lose your pension later.

I understand you are frustrated with the system but you seem to be railing against physician income only. as if that is the only (or maybe biggest?) problem. if this is what you think I am afraid you missing so many other ways to achieve meaningful reform. the problem list is long and part of the problem (as usual) is the gov itself. look above... see how medicare is throwing money down the drain.... and its not doctors that are cashing in, it is hospitals and hospital admins. but keep railing on docs....

what your asking for is reasonable except that this is what nurse practitioners have been doing for years. fast forward to NOW where NPs no longer want to work "under" doctors. they want to be seen as "equals" despite years less of training... in addition, they want EQUAL PAY. so, the days of seeing a "midlevel" provider are dwindling quickly as NP fight for equal pay and no supervision. They are even going to call themselves DOCTORS!!!!! lol.

(I know that somebody is going t come along any moment and call me a liar. please, before you do this, do some research.)

not to repeat my previous post but I think that some gov intervention would be nice but what you got from the ACA is not what you think you got. an ACO is a good idea on the surface but the bill could have done so much more to cut costs. it did nothing to address the single biggest reason the system is so expensive.... peoples bad life style habits... it did nothing to increase revenue (no VAT like tax), did nothing to curb the cost of durable medical goods (actually made them more expensive), did nothing to curb legal costs (again, just drove those up), did nothing to address the expense of prescription drugs... the bill was essentially a bait and switch: look at Europe and Canada, aren't those systems great!!! o wait, our bill did nothing to even remotely make us like one of those systems. lol

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. :rolleyes:

I guess I need to elaborate. I think the whole system is the problem (from big pharma pushing expensive meds that aren't even better then the previous versions, to insurance companies, medical supply companies, to drive-by specials).

The two groups I think gets the shaft are the GP's and ER docs, from what I hear most don't make more then 150-250k a year and bust their arse doing it.

1) I am against the ACA as it's a pile of poo with a couple nice bows on it.

2) I agree the government getting involved will usually mess it up and make things worse. I am not under the illusion that the government will make things right. I expect them to make things worse.

3) Government gets involved when an industry can't seem to get it's head out it's arse and come to some meaningful self-regulation. It's been years of watching things get more and more fraked and more expensive. How can anyone not in the industry not see that if they didn't come up with something meaningful that the government would do what it did.

4) ACA did not pass because people wanted "free health care", ACA got passed because people were sick of what was going on. When health insurance started exceeding the cost of people's mortgages, and the insurance companies looking for any reason to deny claims. When people get charged $10/pill for something they can buy at a cornor store for $4 for 30 pills, things start to stick.

True Story / Helpful hint: If you are a Kaiser member, check your prescriptions against Walmart's/Target's $4 prescription list. If it is on there, ask your MD to print out the presciption go to walmart and tell them you don't have insurance and buy it for $4.

I am amazed, that after paying Kaiser $1300+ a month for health insurance the co-pay on 3 of my 4 prescriptions were $15 and walmart had them for $4/each without insurance. How fraked is that..

The $4 prescription thing really grinds my gears too.

Why? $4 prescriptions that are offered at these places are offered at that price if you have insurance or not. Places like Walmart and Target are baiting you to come for these prescriptions that they make no money off of because you'll go there for all your prescriptions as well as additional shopping. The $4 generics exist for the sole purpose of getting you through the door.

It's because (true story)

30 day supply of generics - Kaiser Insurance at a Kaiser Facility (at 1300/month)
Cost 68.70, Co-pay $15.00 (Amount I pay with insurance $15.00)

The same 30 day supply of generics - Walmart with no insurance $4.00

I am not upset at walmart/target, I am upset at Kaiser. I am locked into their pharmacies and pay $1300 a month for their insurance and they charge me 3.5X the cost of the prescription that I can get at walmart without any insurance.


(Disclaimer, I should update that I dropped Kaiser as my healthcare provider very recently ~1.5 months ago, due to several issues like the above)

Right, I get it, but what I mean, is that it grinds my gears that the co-pay is higher than the total cost of these generics. Obviously, you can go get them at the low price anyway (sometimes you have to specify to NOT apply insurance). You force employers to offer say, birth control coverage, which is negotiated at $60 a month so the premium is about $22 a month for coverage from everyone (men and women because the law is going to force them to be the same if I recall correctly) to get a $15 copay on a drug that is $4 at walmart or target.

Right ... and the previous poster was trying to explain to you that Walmart/Target only offer a (very limited) $4/generic formulary b/c the cost is subsidized by the other stuff you'll buy when you come in for the medication. So in effect, you'll end up paying quite a bit more than $4 (on average) for that $4 prescription.

In addition, there are many Kaiser plans for which you only pay $15 for a 90 day supply of generics (and for some plans, they'll actually just charge you $10 for a 90 day supply if you have your meds mailed to you (free of cost) instead of picking them up at the pharmacy). Your employer probably went with a cheaper plan. Maybe you need to talk with HR.

I am already paying 1300 a month to subdize ... bah let's try an example...

Let's say you sign up for Costco to take advantage of the pricing, you pay your annual dues, then go shopping. The next day you go to walmart and find everything you bought at 1/3 the price. Wouldn't you be pissed at paying the membership fee?

I am already (was) paying Kaiser a tidy sum to subsidize my health coverage, so I expect to get my goods/services less then what a person without insurance pays. Let's try another example..

You get health insurance, go to the hospital with a broken arm, insurance pays X, you pay $300 in co-pays. You find out your friend also went to the hospital without insurance and paid them 50 for the same service. Wouldn't you wonder wth you were paying for insurance to be more out of pocket then someone without insurance.

Plans vary by state, here it is $15/30, $30/90 mailed or $12 bucks for 90 days at walmart.

Sorry but I trust our HR department over random_internet_person_01

Your examples are terrible and have no bearing in reality. The reality is, Walmart/Walgreens get huge price breaks due to volume, plus they make those drugs loss leaders by marking up other drugs. KP on the other hand keeps prices flatter overall. Yes, that means you may pay more for that el cheapo generic, but it also means you pay a crapload less on more expensive drugs than if you had another plan. Not to mention, the joker of a pharmacist down at Walgreens doesn't have access to your lab values, medical chart, full med list etc. All information that helps the KP pharmacist catch mistakes, make recommendations to your PCP, or optimize your therapy.


No, plans vary by both state and the available options KP gives your company to chose from. Sorry, but I trust someone who has worked at KP (me) over a brain dead HR rep who cares more about their company than about its employees. It is entirely possible your company went with, or was only offered the lowest tier plan.


Oh, and SigX, what up bro, you gonna share your Big Pharma kickback $$$ from 2012 or not? You want people to get angry about CMS paying docs extra who work out of hospitals, how angry they gonna be when they see their doc is a prostitute for big pharma, pushin brand new drugs that are 500% more expensive and yet likely not even 5% more effective. Or did I hit a nerve?

1) Lets compare apples to apples then. I'll compare what it would cost using walmart's pharmacy for my chronic meds, vs using your insurance (my insurance plan with Kaiser actually has zero co-pay for everything, including meds, imaging and office visits, so probably not a fair comparison).

The Rules:

I used Walmart's online lookup system for the example below. For the ones that it wouldn't list a price, I used average retail prices as listed by drugstore.com. Walmart also gives a ~ 20% discount for their generic meds if you get a 90 day supply (so 3 months of a $4 generic = $10 instead of $12). I factored that in to the calculations. Kaiser gives a 30% discount on 90 day supplies for many of their plans if you get it mailed to you instead (effectively waiving one co-pay). I DIDN'T factor that in to the calculations.

The Meds:

I take a few meds for some chronic health conditions. 5 are generic, 1 is brand-name only (generic didn't work as well in that case).

Of those generics, Walmart only has 3 on their $4 formulary. The 90 day supply total for those comes to $30 (pretty good deal!).

One generic (which has no substitute, except for its parent brand-named drug) is $24 for a 90 day supply.

Another generic is not on any discounted formulary at Walmart, nor are any of its equivalent generics. It just says "Retail Price". Drugstore.com lists the average retail price for a 90 day supply of this medication as $84

The final medication is a brand-name (since all of the generics I tried didn't work well enough, and I went through 4 alternatives first). This medication's price is also not listed on Walmart's website (just says "Retail Price"). The average price for a 90 day supply as per drugstore.com is $702.

Now, I really don't' want to hear any whining about the "Retail Price" estimates not being accurate. So let's say, just for the sake of my sanity, that Walmart is super-competitive, and prices its "Retail Price" meds at HALF the national average.

So, lets do the math:

Retail Priced meds = ($702 + $84)x 0.5 (Wally-world discount) = $393 for a 3 month supply.

$4 formulary meds x 3 = $30 for a 3 month supply

Generic discounted formulary med = $24 for a 3 month supply

Grand total = 393+30+24 = $447 for 3 months of my medications at Walmart.

Assuming your Kaiser plan follows the highest tier pricing scheme (until you get to a high-deductible plan, where you basically pay full price for everything until you get to your deductible):

$15 per mo for generic, $35 per mo for brand-name forumulary, and $45 per mo for brand-name non-formulary, and assuming that for some reason you DON'T take advantage of the 30% discount for having your meds mailed to you, and assuming that the brand-named med is not on the branded formulary:

$15/mo x 5 meds = $225 for 3 months
$45/mo x 1 med = $135

My total cost using your insurance and VERY conservative math (in Walmart's favor): $360 for 3 months of my medications at Kaiser .

Mind you that many Kaiser members have far cheaper co-pay tiers than what I used. Yours actually is on the higher end of the spectrum for an employer-subsidized plan.

To recap:

Walmart (assuming massive discounts): $447
Kaiser (heavily over-estimating the cost): $360

So your "club membership" (which is really not an appropriate analogy for HMO insurance, but whatever) buys you, at worst,, a 20% discount on you meds. That's also assuming that you NEVER EVER buy anything else at Walmart when you pick up your meds. Also factor in the cost of gas and your time having to drive over to Walmart (all Kaiser plans include free delivery of your meds to your home. You can request these refills online or by phone (or in person, but that would kind of defeat the purpose)). You can also get them mailed to you out of state if you're travelling, or studying out of state (as a lot of students on their parent's plans do).

2) The Walmart generic med list is mostly a marketing scheme - it brings people in, and increases good will in the community. Its not really designed to cover the cost of the meds + overhead. But like all marketing, it IS designed to increase profits OVERALL, mostly by convincing people to give you more of their money than they would otherwise. Try not to loose sight of this very transparent and common strategy - the loss-leaders. Your insurance company doesn't use that business model, so yes, on a very few select items (which represent a minuscule part of your total cost of coverage), you might be able to shop around and get a better price. That's hardly shocking.

3) I'm still puzzled by the high monthly premium you're paying though. $1300 x 12 = $15,600 for just one person?!?!. What the heck kind of Cadillac plan is that? Is your employer even contributing anything, or are you bearing the full cost of insurance? My friend, who has serious cardiac issues (congenital heart disease, requiring lots of expensive specialist visits, regular and very expensive cardiac tests, and a high risk of multiple complex surgeries over his lifetime) pays about $25,000 per year fully out-of-pocket for his insurance, and this covers all 5 people in his family for a "Cadillac" type plan. So that's ~ 5k per person, or about $420 per person per month. And that's without any contribution from his employer (he's considered an independent contractor). Maybe there's some unique details about your health that you want to keep private, but the cost does seem exceedingly high for a single subsidized plan.

Kaiser Comprehensive -
1337.00 per month family plan (3+ members) 50/50 employer/employee split.
No pre-existing condition exclusions, no charge room and board hospital stays
6000 max co-pay (excludes drugs/medical equipment/etc) no yearly limit, no lifetime limit
I call it the 15 plan, just about every co-pay is 15 (doc visits/labs/drugs/etc)


It's 15 co-pay for any prescription (generic/name-brand/formulation) it that helps.

In your case and example it works out to your benefit, in mine it doesn't. The fact that we are comparing a *health insurance plan* -vs- *not having insurance* should be telling.

It only really works because of 1 specific brand name expensive medication, take that out and let's compare...

Grand total = 30+24 = $54 for 3 months of your medications at Walmart.

Grand total = 4 X $15 = $60 for 3 months of your medications at Kaiser

The only real benefit I can see of health insurance over a hsa (and one of the reasons I haven't switched) is the discounts that I can't seem to get with the hospitals and doctors.

That 4,000 er visit for a couple stitches magically comes down to 1,700 and a 105 dollar copay with insurance.


Actually you do make a decent point here. It would be about total overall cost, and if a hospital stay is involved then there is no comparison.

However those miniscule items are a vast majority of my experience with Kaiser over the years. While I can count the number of years that I have required a hospital stay on one hand, the number of years where I have needed a prescription would take both hands, both feet and some other parts of my anatomy.

It's not just the $4 generics. I use a presciption tooth paste (Prevident) 15 bucks Kaiser -vs- 15.47 Warmart. It had gotten to the point where I would call walmart for every prescription (not just the $4 generics) to compare prices. Unless it was for a specific brand name or formulation the prices (in my experience) were within 10-50%..

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.

FYI, I almost excuslively use generics when at all possible. So to that end I agree with you 100%. But based on your attitude in this thread you clearly dont have a problem with government waste, you would rather just point the finger and make shit up. Excuse me if these millions of dollars of waste per year doesn't bother you any,

I remain unclear as to why people are not against government waste. is it cause we have a democrat president that did not fix this with his ACA bill?

It's because most of us have $$$ and premium healthcare (in other words IDGAF) OR are so poor that the current system is better than nothing.

Maybe you are right, IDK. Seems to me that we all benefit from less waste... i mean, more money saved from waste means mroe money for the recipients (more services or less cut services next year). for those with $$$ it means its more likely medicare will be there when they retire. its a win win for everyone. the only people who might not care are the people who benefit from said waste.... i can at least understand that. but i think it s far more political than that.... Democrats dare not show thier displeasure with a government program... you know, thats not good for politics.

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.

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.

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]

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 :lmao:

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.

do you ever engage in conversation without being a jerk?

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...



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
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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.

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.

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 :shake:

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.

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.

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

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.

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

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

Strawman. Of course we can focus on both.

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.

every week? where you get that from??? maybe 2x per week... but you got to remember the dinner is usually 3 hours long.... its really not worth it and most docs dont go. but that has already been explained above. they are NOT popular.


bribed? this is nothing more than yet another baseless attack....

in the same thread??? thanks for changing the focus.... have you given your opinoni on the OP yet? are you happy hospitals are getting this money?

of course, all businesses want to get the word out.

As I mentioned, I have a friend who goes to these things a lot.

But she's a nurse, not a rich doc, which is why I asked if docs go.

Have you taken a survey to find out how many go?


A free meal to influence your recommendation is essentially a bribe.

I'm never happy when the government is paying more than they need to.

And court favor with the gatekeepers, who are influencing their customers to spend money on their products.

have you taken a survey? you are the one assuming docs go weekly. remember this quote:

Its pretty commical when you act like docs do this weekly yet get snippy when I suggest they dont. please feel free to post your link supporting your claim.

bribe assume the doc will prescribe, but there is zero expectation of this.

court favor is not a bribe.

They are available weekly, are they not? I never claimed any particular doc, nor even most, go to them weekly. But they could, and that is my point.

Neither of us knows how many nor how often. Just that there is that potential. Seems you're claiming it's only a conflict of interest if too many go too often.

That's only a valid assumption if there is a penalty for not prescribing. There may be no "expectation" but increasing prescriptions is the reason Pharma does it, so it is not unreasonable to assume it is effective, or they wouldn't do it.

OK, sure. :rolleyes:

with EMRs comes some positives and negatives. the point is that the gov is offereing money to docs to adopt EMRs. there are several problems.... most dont talk to each other so the info does not follow the patient, even if they want it too. Even if using the same info, the hospital does not have to allow you access (the biggest problem). Cloning (copying endless amounts of useless information). then there is the loss of efficiency (many of the systems slow people down). finally, the way the gov decides if you get any money.... they change the rules every week (and recently were going to cancel the program during phase 1 with 2 left). its just another government farkup.

no they are not available every week. that is complete BS. the most I have seen would be every 2-3 months, at max.

no, i never said there was no conflict of interest. i said its not a bribe.... which its not.


of course its effective.... many docs dont read the journals every single day.... just cause scripts go up DOES NOT prove that its innapropriate or "wrong" that they went up. some new medications are crap and others are true steps in the right direction and having a drug rep bring that to your attention (so you can read the journals and review the evidence for yourself later) is not always a bad thing. your assumption that all doctor-rep interactions are negative for the patient is complete bullshit.

so if i prescribe a lot of drug X and the rep invites me to dinner (and I go) and my prescriptions have not changed (cause i already used said drug) I just received a bribe in your opinion??? thats some twisted shit. i suppose you think all doctor should turn off the TV or radio when a drug is being advertised?

Would that not depend on your area? It seems they are available more often in large cities.

We'll just disagree. Clearly Pharma has an expectation that it will get you to do something you'd otherwise not do.

Good thing that is a hyperbolic strawman then. You've already abdicated on the conflict of interest thing, so it seems there is at least that potential negative for the patient.

If it doesn't change your behavior, then it was an ineffective bribe. Clearly Pharma wanted to change your behavior, but you did not cooperate. Congrats, I might add....

More desperate strawmen FTL.

more unfounded claims...


but is it always "shouldn't" do? can you except the fact that some new drugs should be prescribed over old ones?


it could be bad for the patient only if there is an equally effective generic drug available.


if one meal serves up this much distaste for doctors then you must really hate politicians.

desperate to find you a dictionary.

As I said before, my friend goes to these things regularly.

Sure. But if they were really that good, why would it take fancy dinners to get the word out?


Or a better one from a company that cannot afford a large marketing budget.

Last year, my sister prescribed me Flonase. This week, I found out there is a generic.

Not sure if it existed last year, or my sister just did not know about it, but it could have saved me some change.

How did we get from a meal every week to only one?

I wasn't talking about you personally. You could be one of the special docs who is not influenced.

Cause you think I said anything about drug advertising on TV?

great, surely your understand that your friends actions as an individual do not define the masses.


??? this is how the business world has worked for ages. so if you discovered the cure for cancer, you would not try and advertise your drug to docs??? ok.


maybe you should find a more conscientious doctor? maybe you should have asked if there was a generic (or lower cost) alternative? maybe she needs a better EMR (mine tells me how much it will cost the patient BEFORE I prescribe it)?


why not? you seem to take a lot of liberty is claiming how often docs go to these, so why cant I? between the 2 of us I clearly have a lot more direct experience with these events yet you seem to be unwilling to listen....

I wasn't talking about you personally. You could be one of the special docs who is not influenced.[/QUOTE]
[QUOTE]I am not stupid enough to think that I am not influenced at all. all humans are effected by advertising. myself included. but when I prescribe I always consider the pros/cons with expense.


no, cause I think you use bribe inappropriately.

But her knowledge does define what is available here, so it's not unsubstantiated.


If there were a cure for cancer, would you have to go to a fancy dinner to find out about it?


Or maybe she was overly influenced by the Flonase manufacturer....


I made no claims about how many times any doctor or group of doctors go to fancy drug dinners. I made a claim about how many opportunities they have.

Trouble is, a fancy dinner has more influence than mere advertising. That's why they do it.

What does that have to do with your hyperbolic strawman about you not watching TV ads?

link please. that is the standard in the podium, not hearsay.



what people have to do is irrelevant. what people are willing to do is the question.



not mutually exclusive from what I said. please re-read:

maybe you should find a more conscientious doctor? maybe you should have asked if there was a generic (or lower cost) alternative?



false/ original statement:
implication is that people are actually doing this which is extremely unlikely. any drug rep will tell you that getting doctors to these is extremely hard. we are forced to hear you blabber on about your one friend but you refuse to listen to my DIRECT knowledge on the subject having known hundreds of doctors.

link please.


so your saying that free public tv shows is not bribing people?

Lol, SigX I think nic is just trying to get under your skin. He's just playing Devil's advocate for everything.

Nic, to say "perhaps you're one of those special doctors who is not influenced"....oh come on. Are you really that out of touch with medicine. You know damn well 90% of us physicians couldn't give a flying fark what the rep says. Most of us will prescribe what the patient needs and pick the med we think would work best for the patient. It's not like we're trying to drug patients unnecessarily (unlike some previous douchebag accusations). If a patient needs a statin or beta blocker we go with the one that best meets that patients needs (price vs complications vs efficacy vs compliance).

The time that the drug rep influence works the most is when we dispense samples. The reps come to the office, give their spiel, and drop off samples. If I start somebody on some new med, I usually use (well used to use, I don't do office work anymore) the samples. If the drug works for the patient I continue them on it and try not to do the medical merry-go-round. In that case yes the doc is influenced and I see this happen frequently. But we're smart enough to know not to prescribe a $200 med when a $20 one will do the trick - no patient is going to take the $200 drug and noncompliance will be an issue. What the reps were trying to do was to keep us from prescribing the other guys stuff, not write Celexa for everything that walks through the door. You think they let country bumpkins into med school (OK, well they let me....)

Let go of the dinner thing. It's pretty rare to see those nowadays (and I live in LA - you can't get more metropolitan than that). Like I said the last time I went to one was in 2007 and I was single all the way until I met my wife at the end of 2008. I could have been having $100 meals every night...yeah right. Not going to sit through a 4 hour powerpoint lecture for some silly dinner. Remember you said a long time ago any 1/2 decent doc should be able to make enough to play golf every afternoon and I went off on you (I was seeing all the unwashed masses of 90241 and making less than your nurse friend per hour I'm certain). You think we're going to sit 4 hours for a $100 meal...$25/hr....why the hell aren't we out on the back 9 (whatever the hell that is, I've never played golf in my life).

Senor Danza...I don't use an EMR currently as all my notes are still written in the patient's chart at my hospital but I used to use EMR when I had an office. CMS has learned that EMR now is rewarding physicians too much since prior to EMR we were always downcoding (underbilling) for fear of getting audited. Now the EMR program does the billing and it's CMS's own damn fault they have to pay physicians more (since its automatically charging higher codes cuz us physicians are documenting too damn much). Sadly the motivation for CMS to push EMR was for costs, not to reduce medical errors (which is currently higher with EMR - can you see grandpa doc over there copy pasting his notes for a prostate exam on a 67 year old woman). So EMR is currently costing CMS more and causing more medical errors. And some of them are so horrid,spitting out pages and pages of useless paper with no meaningfull information on them - again stupid programs coded by morons. It was a rush to get out crappy products because they knew docs would have to buy them nomatter how shitty. Imagine how crappy Prius and Volt and Lead would be if the gov mandated that we all had to buy them - there would be no rush to innovate.

I would love to see a national standard on EMR and have it delivered for FREE by the government (hell, they're making us involuntary federal workers, they should give us federal forms just like at the Post Office). I would love if I could see a CT done at some other hospital 3 years ago for every Medi/Medi patient I have. Unfortunately Congress has like 6 physicians and 3 of them have their head so far up their ass and removed from medicine they don't know what it's like to see patients anymore. All they would need to do is hire 2 docs of every specialty and have them put in requirements for a comprehensive program, have some IT guys code it, and then bam spread it across America. Too expensive? I don't know, seems we can print $1 trillion dollar coins now ;)

Your actually going to an event nothwithstanding, I was talking about the opportunity, not your personal practice.

I said every week, not every night.

No, I don't remember that. You sure it was me?

But really, golf is not that expensive. But if you're out playing golf, you're not billing hours, so there's tradeoff there.