The financial reality is more important than survey responses. In a reimbursement system based on rewarding service volume, there's always an incentive to offer additional services/tests/health care widgets. That means that even if physicians admit to practicing defensive medicine (acknowledging that external incentives independent of best clinical practices influence their actions), that doesn't imply that tort reform alone will eliminate, or even materially reduce, unnecessary service volume. And indeed tort reform experimentation in the states hasn't offered strong reason to believe it will. And that's because those extra, unnecessary services are still a revenue stream. There are reasons to do smart tort reforms but by themselves they're not a silver bullet for addressing health care costs.
Not true: There is absolutely zero financial incentive for a physician, such as myself, to practice defensive medicine. Let's take an example: A 90 year-old patient with advanced dementia who resides in a nursing home had a witnessed fall with some minor head trauma (let's say she fell off her bed onto a carpeted floor). Since her physician in the nursing home fears a lawsuit if an injury related to the fall is missed, he immediately tells the staff to call EMS to bring her to an emergency department. The emergency room physician then examines the patient, and, even if there is no sign of physical trauma to the head, will undoubtedly order a CT scan of the head to rule out a intra-cranial bleed to protect himself from a frivolous lawsuit from an unreasonable relative. The best part of this scenario is that even if the CT scan is positive for a bleed, no neurosurgeon would take such a patient for such a risky surgery. The nursing home physician did not get a penny for sending the patient to the emergency department, and the emergency department physician also did not get a cent for ordering the expensive CT scan. Tests like these that are done to avoid potential lawsuits are done thousands of times every day in every state of this nation are of no financial benefit to the physician ordering them.
It's a bit disingenuous to suggest there's "no financial benefit" for an individual physician to provide additional service volume: like other docs, ED physicians can be and many are compensated in proportion to unit services billed or charges incurred in the course of their work. We live under a system in which services, including anything a physician does that shows up on a fee schedule, are billed discretely for incremental reimbursement. Meaning that higher service volumes--and the higher the margin on the service delivered, the better--are the key to generating additional revenue. And thus many physician compensation schemes, even when they're employed and/or have a base salary, tie pay to "productivity" or activity in some fashion. I have no doubt physicians dread malpractice suits, but that doesn't negate the fact that these unnecessary services they're in the habit of providing are a revenue stream. That means flicking a tort reform switch isn't necessarily going to shut off the spigot.
NO, the first place to start is the waste and mismanagement of the Medicare program which is Administered by private Companies selected by the Federal government. Did you know that. Like the IRS CS representatives, the Medicare CS Representatives fail to be able to accurately provide Medicare Insured's and Medicare Providers with accurate information and if the information provided is inaccurate, it is the patient or provider that loses as Medicare is not held to the information they provided. And, if you were a provider you would understand that nearly 50%+ of claims you submit are denied and you have to dispute/refile them. Increasing your administrative costs, delaying payment and possibly costing the patient more out of pocket. There has been no increase in Medical payment for services provided since I don't know how many years, loss track. All they have delayed is "reducing" fees/payment/reimbursements all these pass 10+years. And, the current piece of Legislation in Congress only stops the need to "over-ride the law requiring a decrease in reimbursements" it does not provide for increasing reimbursements in line with rising operating costs and the cost of providing medical care. People object to laws and legislation they have no full understanding of, basing their position on biased news reports. You must start researching and study the history, the facts and reading past and current legislation regarding a given topic. Stop believing the biased news, the partisan representatives and the various political party talking points. Be your own person, not a sheeple.
Again, you are stating a falsehood. Doctors are not compensated based on the number of tests they order. For instance, if a nursing home patient who was found on the floor by the nursing home staff is brought to a local emergency department for "possible head trauma," and the ED physician orders a CT scan of the head to rule of a bleed (even if there is no sign of trauma on the physical exam and the patient has no complaints of pain), the ED physician will not see a penny for ordering the CT scan of the head. The only reason why an ED physician would order a CT of the head is to protect himself/herself from lawsuits in the rare likelihood that an intracranial bleed occurred. Again, we are talking about physicians ordering tests to protect themselves from lawsuits. Like I have said many times, physicians do not financially benefit by ordering these tests (I should know, since I work in a hospital as a physician). You are disingenuously conflating service volumes (e.g. number of patient's treated) with number of tests ordered. I hope you understand that these are not the same thing. Additionally, "high margin of service" has absolutely nothing to do with the number of tests order. Rather, it has to do with the complexity of the case. For example, an ED physician treating someone for simple constipation would bill less than he would if he was dealing with a patient who came in with respiratory arrest that required intubation. You are again changing the subject entirely. We were supposed to be discussing whether or not doctors benefit by ordering tests to protect themselves from lawsuits, but you seem to want to instead talk about the fee-for-service model, which is an entirely separate discussion. On a side note, there are plenty of jobs besides physicians that offer productivity bonuses. Again, the fact remains that doctors do not see a dime by ordering these tests. That's illogical. Why would doctors continue to order unnecessary tests (that are time consuming to follow up and provide no financial benefit) if they no longer had to fear ridiculous lawsuits?
The members comment is correct that Doctors are not compensated for the tests they order another provider to perform. The could over 100 lab tests, an ultrasound, a C.A.T scan but would be paid "zero" for doing so. They aren't even paid to read and interpret the test results on the those ordered tests. They use the results of the tests to make a treatment plan for the patient. They aren't paid for prescribing drugs, refilling prescriptions. That is why many now require you come in for a visit before they will refill your prescription. They no longer give out drug samples because of the over regulation passed by the Federal Government on accepting samples from Drug Companies and storing them and distributing those samples. They now send you to private labs to draw your blood for sample because medicare and now private insurance won't pay them to draw it. Ends up costing you/your insurance more. And is time consuming for the patient. Regarding tort reform, you can blame lawyers for the rise in malpractice insurance costs and the frivolous lawsuit dilemma. There are many cases where a surgeon, hospital, doctor causes undo injury to a patient. And where that happens no one suggests the patient or their family should not receive compensation. But, due to how our legal system works, lawyers take malpractice cases on contingency, meaning the individual claiming harm pays nothing out of pocket toward their legal costs. All to often lawyers take these cases betting on the fact that the malpractice insurance company will offer a settlement out of court and the lawyer will make even more than their client after the settlement. More and more Doctors/provider insured's are demanding their insurance companies to take their case to court and a huge percentage win. IMO the cost of malpractice insurance is a small percentage of the rising cost of health care. First and foremost, health care is a private business. Phyisicans in private practice have all of the same business overhead that every private business has. Plus they have the added regulatory costs which are mounting. These costs continue to rise yearly while Medicare and Medicaid reimbursements remain stagnant and private health insurance reimbursements follow closely behind. At some point, when cost and reimbursement are equal or reimbursement is less as is now the case with Medicare and Medicaid, treating patients with X insurance becomes no longer cost effective.
Good post. Here in Florida doctors are falling all over themselves to provide service for Medicare patients so I assume it is still very profitable. Medicaid I have no idea about.
Are illegal aliens counted in all censi ? Is it possible illegal aliens do live past the national life expectancy? Do you think a couple of thousands killed by gangs impact greatly on national life expectancy? I don't think your ideas hold a lot of water considering Europe actually has a lot of illegal immigrants and guest workers especially from Africa. Why is Australia ranked 10th while Australia has a large multicultural society? Australia also has the same obesity problem than America and very similar lifestyles. I'm not saying American healthcare is solely responsible for the low life expectancy but something is amiss, especially in a wealthy developed technology advanced country.
Unlike other developed countries, U.S. HealthCare system is structured as a private business. The goal of any business is to make money, from that perspective, there is absolutely zero incentive to keep population healthy. The problem is that majority of people in U.S. do not understand that very simple concept, so they do not even ask government to change anything.
They are in a business but with Supposed ethical standards this is the Declaration of Geneva from what I would assume is one of the major internationally respected organizations of the physicians calling. http://en.wikipedia.org/wiki/Declaration_of_Geneva Noting this one: I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; So social standing or other factor cannot intervene between your duty nor social standing if your not treating the poor refusing to take some Medicaid and Medicare patients I think calling you unethical and immoral is sound, what harm would it do to take out of every 100 patients just four Medicaid patients, it would meet the needs of the poor and you would argue within your means your taking all you can. Instead of the immoral they are poor so f$%^ them its not my problem even though by inaction my profession and myself are doing harm.
You are talking about what the Government spends on health care. That is Medicare, V.A. and Armed Forces. Not what is spent on Private Health Insurance paid totally by the insured. Whether Corporate, Small Group or Individual Policies. And when it comes to waste, it is the Government run health care programs that experience the most waste. So why would you want to expand an already non-efficient system of providing health care? Makes no sense. Hum? Which is likely more efficient and less wasteful, the Government that has unlimited funds to administer a health care program, or a Private Insurance Company that relies on efficiency in order to earn a profit? Think about it.
Please feel free to document that waste in Medicare is higher than waste in other medical insurance plans.
Really, perhaps that is because their patient base is elderly and on Medicare. And, it depends upon what type of physician or surgeon they are. Because, Medicare reimbursements haven't increased in a decade and barely cover the cost of providing the patients care or surgery. So, I find you comment interesting and I will check it out.
Seriously, ok I will work on doing that, but since I worked in Government medical care and private medical for over 35 years, I guarantee you that private insurance companies have incentive(called making a profit) not to waste money through poor management of their programs. While the Federal government has unlimited tax payer funds. Its really a no brainer. - - - Updated - - - For one thing, illegals likely are uninsured and seek E.R. care therefore they contribute to higher premiums the rest of pay.
It doesn't matter what type of physician or surgeon they are. Doctors are setting up offices here in the Villages at an unbelievable rate and it is true that most are older and on Medicare and have supplementary insurance. Don't know how it works but I doubt that they are opening offices with the expectation of losing money.
That is exactly the reason why private health insurances should be illegal. Because they are making profit, that jacks up price of the health care. Their efficiency cost too much money for the population, that is why we have to have, may be less efficient, but much less expensive government healthcare. Of course, no one advocate to eliminate entrepreneurial medicine, whoever want to pay efficient price can go to private hospital.
Here in Central Florida the testing facilities are owned to a large part by groups of doctors so ordering unnecessary tests makes the doctors money. Also doctors of different specialities are members of he same alliance so ordering more tests and specialist visits is financially beneficial to the doctor ordering the specialist visit. Defensive medicine here is basically defensive for a doctors income not defense against lawsuits.
Yep, that is outright corruption, unfortunately it is absolutely ignored by general public. Apparently people are happy to have Medical Cartel in U.S.
I am not willing to call it outright corruption although it certainly has a significant potential for conflict of interest.
I am not certain if census data is used in calculating life expectancy. For instance, if an illegal alien with terminal cancer dies in my hospital, it is still required that a death certificate is filed out, regardless of the patient's legal status. The age of the patient's death with be on record, regardless of his/her legal status. It's not very logical that an impoverished population with less financial resources to obtain many healthcare treatments would outlive a population that has better access to healthcare treatments that could significantly prolong their lives, even though Hispanics, as a population, have inherently longer life expectancies in America compared to their White counterparts (81.2 years for Hispanics vs 78.8 years for Whites according to the CDC in 2009). Since the poster that I was responding to was making a big deal over a fraction of a percentage, then I certainly do think that several thousand people dying in their teens, twenties, and early thirties can account for this fraction of a percentage. The USA has between 11-15 million illegal alien residents. Does the entire continent of Europe have anywhere near that amount? Does Australia have over 40 million people of African backgrounds who have inherently lower life expectancies due to higher rates of diabetes and more refractory hypertension? I did not think so. The point that I was making is that America does not have a significantly lower life expectancy compared to other countries. Our life expectancy is 79 years. The average life expectancy is Europe is around 81. To me, that's not a huge difference. Additionally, we have 50 individual states in the USA, and life expectancy varies by state. For instance, my home state of NJ has an overall life expectancy of 80.3 For Asian-Americans in my state, the life expectancy is nearly 90!
Yes, it is pure speculation, there is no official statistics that supports your ideas. U.S. is far behind other countries in Health Care, especially in infant mortality.
LOL! The only speculation is coming from your keyboard, since, unlike you, I actually included facts that support my position. Can you read? My prior posts have included data from the CDC. That's entirely false. The infant mortality rate is 5.4 per 1000 live births (as per the United Nations Population Division). Canada's infant mortality rate is 5.22 per 1000 live births (as per the United Nations Population Division). Hence, there is no statistically significant difference between the infant mortality rate of the US and Canada. In addition, New Zealand's infant morality rate is 5.07 per 1000 and the United Kingdom's infant mortality rate is 4.91. Hence, you are clearly lying when you state that the USA is "far behind" other countries regarding the infant morality rate. Moreover, the most common causes of infant mortality have nothing to do with how healthcare is administered. These causes include congenital malformations and deformations, chromosomal abnormalities, and sudden infant death syndrome. In conclusion, please become more educated before posting nonsense (it would help if you actually looked at some factual data that may support your position).
Here is an official ranking of the countries by infant mortality rate. It shows that U.S. is far behind. https://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate For the money people are paying for HealthCare in U.S. it not just bad, it is outrageous. Even though your position is supported by several facts it is still personal opinion. Personal opinions are not the facts. Once we have reputable report how good U.S. Health Care is we can have meaningful discussion, until then the fact remains unshattered. http://www.commonwealthfund.org/~/m...rt/2014/jun/1755_davis_mirror_mirror_2014.pdf U.S. has a worst Health Care system for people, but best one for moneymakers.
Yes: Wikipedia uses the United Nations Population Division data (which is the data that I cited). If you look at this data, you will see that the USA is #34 and has a statistically identical infant mortality rate to Canada, and our rate is only slightly worse than the UK (5.4 per 1000 for the USA vs 4.91 per 1000 for the UK). We pay more money because of our broken civil legal system that allows ambulance chaser lawyers to sue doctors for looking at their patient the wrong way. This leads to defensive medicine, which costs $650 billion every year. http://www.forbes.com/sites/realspin/2013/08/27/defensive-medicine-a-cure-worse-than-the-disease/ You need to learn the difference between facts and opinions. It is a fact, not an opinion, that the USA has an infant mortality rate that is statistically no different than Canada and only slightly worse than the UK, according to the United Nations Population Division. I believe that I quoted this paper before regarding the USA's exorbitant healthcare costs compared to other countries. There is little doubt that these costs are related to our broken civil legal system and defensive medicine that it leads to. This baseless statement is not backed up by anything that you have presented. In fact, this statement is in stark contrast to the paper that you cited (http://www.commonwealthfund.org/~/m...rt/2014/jun/1755_davis_mirror_mirror_2014.pdf). From this paper, it is stated, "The U.S. is third on effective care overall, performing relatively well on prevention but average in comparison to other industrialized nations on quality of chronic care management." Only the UK and New Zealand scored higher on effective care, and thus the remaining 8 countries performed worse than the USA. Regarding the other metrics looked at by this paper, the USA again scored third when looking at timeliness of care (only Switzerland and the UK scorer higher). For most other metrics, the USA scored midrange. The only metric that the USA did poorly was efficiency. However, the study defined being efficient as "having an electronic medical record (EMR) system with two or more functions for ordering, patient information, panel information, and decision support," as if efficient care could not be effectively provided without these innovations. In conclusion, it would help if you actually read this paper before citing it, since it seems to buttress my argument while demolishing yours.
