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Post by Deleted on May 18, 2016 11:24:33 GMT -5
Agree with you Elvado. The only area which I feel eeryone should be entitled to is health care. Otherwise we are going down a very slippery slope. While most American's want to work, an increasing proportion of the population does not. Offering freebees to the electorate is a quick way to become popular. The biggest problem is that the once people get an entitlement, it is impossible to take it away.
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TC
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Post by TC on May 18, 2016 14:27:18 GMT -5
God bless the speed with which you defend your man. The steep decline in labor participation and the explosion of those living on the government dole are the logical result of his desire to expand the welfare/nanny state. It's pretty easy when for 8 years you've chosen the most disingenuous and trivial lines of criticism possible against him. Labor participation rate is weak sauce even for you.
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Elvado
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Post by Elvado on May 18, 2016 15:10:27 GMT -5
So there you have it. TC has spoken.
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EasyEd
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Post by EasyEd on May 18, 2016 15:28:52 GMT -5
Strongly agree with hoyainspirit. While I believe that ACA is poorly constructed, it did give access to health care to millions of those who couldn't afford it. I haven't seen any of those who oppose ACA come up for an alternative for those newly insured citizens and their families. I don't agree with Sanders on much, but I do agree that we need 100% access to health care. As an example, I have a relative who is dating a woman who has rheumatoid arthritis. She badly needs to be on a biologic such as humira, but can't afford the $18,000 to pay for it along with her other medical costs. Incidentally, she is working, butjust doesn't make enough to pay for this. On another note-we DO need the government to step in an stop the outrageous ordering of inappropriate tests, and other procedures by physicians that is driving up the costs of health care. And why so many tests? Law suits.
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Post by Deleted on May 19, 2016 6:41:56 GMT -5
Hi Ed!
My position is that that is nonsense (although it is a commonly used excuse). Let me give you an example of a massively overused test. That is the MRI of the neck or back. Most back and neck patients have multiple MRIs. If the patient is contemplating surgery, then OK. If you have suspicion of a tumor (which has very characteristic symptoms), then OK. However, consider this.
If one has low back or neck pains, I would ask this question, What is going to be different (such as treatment) as a result of the MRI. The answer is simple-Nothing. MRIs do NOT impact treatment. Another point of interest. If you took 100 people off the street over the age of 64 who have NO back or neck pains, more than half would have herniated discs. Also, if you took 100 of those people who had herniated discs with pain, about a quarter of those herniated discs would not be demonstrated on the MRI.
Now the kicker. Let's say you have 200 patients with low back pains and sciatica and you perform MRIs on 100 of them and discuss the results. The other 100 you don't do an MRI. The question is, who has a better outcome? Well that has been studied and the patients who did NOT have the MRI have better outcomes. If anyone wishes I can cite the sources.
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EasyEd
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Post by EasyEd on May 19, 2016 10:31:01 GMT -5
Jerry, I accept what you say but still state that many, many tests are being prescribed as CYA against malpractice suits. Why do you think malpractice insurance is so expensive?
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Post by HoyaSinceBirth on May 19, 2016 11:05:38 GMT -5
I think Jerry and Ed are both right in this case.
As a medical student Jerry is right especially about MRIs and low back pain. Heck they've even shown people who get back surgery for these pains are no better off than those who don't get surgery 10 years down the line. There's a lot of waste in medicine and not all of it is fear of malpractice. A lot of it is the system being poorly designed and physicians either not knowing any better or being too lazy to fight a patient on ordering a test they don't need.
But I do think tort reform will help reduce some unnecessary testing. Lots of tests are done to cover doctors butts. But sometimes it's good because doctor's judgements aren't perfect so sometimes that test that seems unnecessary and you just ordered to "be through" ends up coming back positive and saving someone's life.
Overall another thing I think will reduce health care costs is recognition of the limitations of modern medicine and allowing for more palliative care at the end of life rather than throwing money to increase life expectancy minimally. A lot of people have unrealistic expectations about what medicine is capable of. Doctors are more and more having conversation about patients having a living will/advanced directive and determining what type of end of life care they would want. I think more and more people are opting for less invasive procedures and choosing palliation and dying with dignity. But I think a lot of people don't realize 1) how rarely resuscitation works when people code I think it's somewhere around 10% if it happens in the hospital and less than 5 if it happens out in the field. 2) how invasive and painful and brutal it is. If you don't break ribs doing CPR you're probably not doing it hard enough to bring them back.
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Elvado
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Post by Elvado on May 19, 2016 11:08:45 GMT -5
I think Jerry and Ed are both right in this case. As a medical student Jerry is right especially about MRIs and low back pain. Heck they've even shown people who get back surgery for these pains are no better off than those who don't get surgery 10 years down the line. There's a lot of waste in medicine and not all of it is fear of malpractice. A lot of it is the system being poorly designed and physicians either not knowing any better or being too lazy to fight a patient on ordering a test they don't need. But I do think tort reform will help reduce some unnecessary testing. Lots of tests are done to cover doctors butts. But sometimes it's good because doctor's judgements aren't perfect so sometimes that test that seems unnecessary and you just ordered to "be through" ends up coming back positive and saving someone's life. Overall another thing I think will reduce health care costs is recognition of the limitations of modern medicine and allowing for more palliative care at the end of life rather than throwing money to increase life expectancy minimally. A lot of people have unrealistic expectations about what medicine is capable of. Doctors are more and more having conversation about patients having a living will/advanced directive and determining what type of end of life care they would want. I think more and more people are opting for less invasive procedures and choosing palliation and dying with dignity. But I think a lot of people don't realize 1) how rarely resuscitation works when people code I think it's somewhere around 10% if it happens in the hospital and less than 5 if it happens out in the field. 2) how invasive and painful and brutal it is. If you don't break ribs doing CPR you're probably not doing it hard enough to bring them back. Let's see how you feel about that in 20 or 30 years, or when it is your relative...
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Post by Deleted on May 19, 2016 11:14:51 GMT -5
Jerry, I accept what you say but still state that many, many tests are being prescribed as CYA against malpractice suits. Why do you think malpractice insurance is so expensive? You are absolutely correct that tests are being ordered to CYO, but actually, only a very small number.
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Post by Deleted on May 19, 2016 11:26:14 GMT -5
Malpractice is so expensive, because it is very expensive to defend these cases. Also understand, that some of these cases are legitimate. Look at what happened to Joan Rivers. She goes in for an endoscopy. Her ENT physician is present and without privileges or consent, she decides to biopsy the vocal cords. And she does this without protecting the airway (needs a tube). Then an uncommon reaction occurs and Ms. Rivers' vocal cords go into spasm and she cannot breathe. In stead of sticking a trocar (large metal tube) into her trachea, they try to get an endotracheal tube until she goes into arrest. Error after error. So physicians have to realize that some of these suits are well founded and they need to stop trying to protect doctors against any and all lawsuits. Lawyers are not filing many frivolous suits anymore since it is so expensive to file and prosecute. Presently, insurers are rarely settling these suits. They are taking almost all of them to trial. So lawyers are thinking twice before filing unless the suit is well founded.
Hoya since birth, are you a student at Georgetown medical school???
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kchoya
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Post by kchoya on May 19, 2016 11:30:19 GMT -5
Jerry, I accept what you say but still state that many, many tests are being prescribed as CYA against malpractice suits. Why do you think malpractice insurance is so expensive? You are absolutely correct that tests are being ordered to CYO, but actually, only a very small number. It's more than you think. However, The bigger cause of doctors ordering tests (and prescribing meds, etc.) is a desire to improve patient satisfaction metrics and prevent patient complaints. Many doctors have compensation arrangements that are tied to patient satisfaction scores. Plus, under Obamacare, the push to tie reimbursement to "outcomes" may only exacerbate this issue.
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kchoya
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Post by kchoya on May 19, 2016 11:31:35 GMT -5
Malpractice is so expensive, because it is very expensive to defend these cases. Also understand, that some of these cases are legitimate. Look at what happened to Joan Rivers. She goes in for an endoscopy. Her ENT physician is present and without privileges or consent, she decides to biopsy the vocal cords. And she does this without protecting the airway (needs a tube). Then an uncommon reaction occurs and Ms. Rivers' vocal cords go into spasm and she cannot breathe. In stead of sticking a trocar (large metal tube) into her trachea, they try to get an endotracheal tube until she goes into arrest. Error after error. So physicians have to realize that some of these suits are well founded and they need to stop trying to protect doctors against any and all lawsuits. Lawyers are not filing many frivolous suits anymore since it is so expensive to file and prosecute. Presently, insurers are rarely settling these suits. They are taking almost all of them to trial. So lawyers are thinking twice before filing unless the suit is well founded. Hoya since birth, are you a student at Georgetown medical school??? I don't know about the lawyers you practice with, but that's not the case in my experience.
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DanMcQ
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Post by DanMcQ on May 19, 2016 11:40:29 GMT -5
Malpractice is so expensive, because it is very expensive to defend these cases. Also understand, that some of these cases are legitimate. Look at what happened to Joan Rivers. She goes in for an endoscopy. Her ENT physician is present and without privileges or consent, she decides to biopsy the vocal cords. And she does this without protecting the airway (needs a tube). Then an uncommon reaction occurs and Ms. Rivers' vocal cords go into spasm and she cannot breathe. In stead of sticking a trocar (large metal tube) into her trachea, they try to get an endotracheal tube until she goes into arrest. Error after error. So physicians have to realize that some of these suits are well founded and they need to stop trying to protect doctors against any and all lawsuits. Lawyers are not filing many frivolous suits anymore since it is so expensive to file and prosecute. Presently, insurers are rarely settling these suits. They are taking almost all of them to trial. So lawyers are thinking twice before filing unless the suit is well founded. Hoya since birth, are you a student at Georgetown medical school??? I don't know about the lawyers you practice with, but that's not the case in my experience. When one can purchase pretty much whatever medical "expert" opinion one wants (many not based in medical fact), it's far easier to get a "frivolous" malpractice action to trial than you portray, JerryLH.
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Post by Deleted on May 19, 2016 12:07:07 GMT -5
Oh, your are correct it's very easy, but horribly expensive. $80-100,000. If the Attorney loses, he is out that much. Malpractice insurers are taking almost everything to trial now. They are not settling much anymore, even when they know they have a losing case. Now I am not saying that there shouldn't be changes. There should be. For example even if there was gross malpractice, if the injury wasn't that great, malpractice attorneys won't take the case. Today they will only take the case on contingency if the damages are great. You are also correct that there are bureaus with "so called medical experts" who will testify to anything.
In my opinion, the best system is the one the Department of Veteran's affairs uses. If you feel you have a case of malpractice, you fill out fairly simple paperwork. Then the case is reviewed by VA doctors and if they feel the doctors were guilty of malpractice, the complainant is offered a cash award. Incidentally, the reviewing physicians are usually pretty fair. The biggest advantage is the complainant does not have to pay expenses or contingency fees. Not only that, if he agrees, the money is direct deposited into his account within 30 days. He doesn't have to wait years. If he doesn't agree, he still has the option to sue with a private lawyer. Not a perfect system, but certainly better than what we have now.
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kchoya
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Post by kchoya on May 19, 2016 15:06:47 GMT -5
God bless the speed with which you defend your man. The steep decline in labor participation and the explosion of those living on the government dole are the logical result of his desire to expand the welfare/nanny state. It's pretty easy when for 8 years you've chosen the most disingenuous and trivial lines of criticism possible against him. Labor participation rate is weak sauce even for you. I missed the part where Obama stopped trumpeting the awesome U.S. economy to admit that the advance metrics, like the participation rate, are still pretty depressing. Maybe you have a link. I don't think he's responsible for all of the decline in labor participation, just don't act like everything is hunky dory with the economy. Same thing with Hillary - I don't care that she made buttloads of money giving speeches to Wall Street, just don't act like you're some anti-big bank crusader. At least Fauxcahontas didn't make 100's of thousands giving speeches to Wall Street.
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Post by HoyaSinceBirth on May 19, 2016 15:33:39 GMT -5
You are absolutely correct that tests are being ordered to CYO, but actually, only a very small number. It's more than you think. However, The bigger cause of doctors ordering tests (and prescribing meds, etc.) is a desire to improve patient satisfaction metrics and prevent patient complaints. Many doctors have compensation arrangements that are tied to patient satisfaction scores. Plus, under Obamacare, the push to tie reimbursement to "outcomes" may only exacerbate this issue. I agree that the ties to patient satisfaction is very problematic as is the outcomes based reimbursement. Most doctors I talk to really do not like obamacare. I think it did some very good things, but that there are some very questionable parts that do not encourage good practice or money saving. You can do everything right and the patient can have a bad outcome either due to patient non-compliance with prescribed interventions or just because medicine isn't perfect and we're only delaying the inevitable in most cases. I think an issue is Doctors receive little to no education on cost reduction or the economics of health care at all. I think it ought to be incorporated into medical school education to produce more cost conscious doctors. Too much of medicine is done just because that's the way we've always done it. We're certainly trying to practice more and more evidence based medicine, but there's still very little training on economical practice. For instance most patients in the hospital get basic labs drawn every day even when it's not necessary in a lot of the cases. But until recently there's been no effort to educate providers about ways to reduce costs by eliminating unnecessary testing (The doctor's not paying for it and likely never sees the bill to realize that even the most basic tests cost at least $50). As for end of life care. I'm not suggesting any such death panels or that no end of life care is good. Just that our culture needs to re-examine 1) What medicine is capable of 2) how we want to live our final days. Patients are often put through painful and expensive interventions and get very little in return. I think the most importatnt thing is to have the discussion and to have a living will to make sure your desires are carried out. Sometimes patients are put through these painful and expensive procedures when they wouldn't want to because they never documented their desires and we have to assume the patient wants intervention unless otherwise specified if they're not able to articulate their desires at the present time. Sometimes it's worth it to try and extend your life a little bit longer for example to be able to attend a special event like the birth of a grand kid or a your kids wedding but other times patients have unrealistic expectations for how far we can extend life in the face of a terminal process. A lot of the time a patient gets a little bit more time but that extra time is spent in agony. Palliative care is often the more humane option that I would choose for myself and loved ones if the situation arose. Obviously every situation is different. and I am not at Georgetown for Medical school, but I'll be applying for residency this year so I'm hoping to head back to the hilltop for residency if the Match Gods allow.
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Post by HoyaSinceBirth on May 19, 2016 18:23:52 GMT -5
Here's a good study showing that higher patient satisfaction actually was associated with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality. archinte.jamanetwork.com/article.aspx?articleid=1108766It was associated with less ER use.
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Post by Nevada Hoya on May 19, 2016 20:33:38 GMT -5
Not all insurances allow the MRIs prescribed by doctors. I have had three MRIs denied over the past three years; none on the back.
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kchoya
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Post by kchoya on May 19, 2016 20:37:09 GMT -5
Here's a good study showing that higher patient satisfaction actually was associated with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality. archinte.jamanetwork.com/article.aspx?articleid=1108766It was associated with less ER use. Link isn't working.
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DanMcQ
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Post by DanMcQ on May 19, 2016 21:36:48 GMT -5
Here's a good study showing that higher patient satisfaction actually was associated with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality. archinte.jamanetwork.com/article.aspx?articleid=1108766It was associated with less ER use. Link isn't working. Worked for me, but try this: goo.gl/al7jpfA Big problem with much of what Congress and HHS have proposed in health care reform over the past decade is that a lot of it SOUNDS great but often hasn't been studied carefully enough before it was put in practice and many things held out as quality metrics turn out not to really be that when you get down to it. Alternatively, good concepts like ACOs are underfunded/under reimbursed to the level that delivering higher quality care in a more coordinated fashion is such a money loser even for organized systems that it is untenable to practice under that model. As an aside, JerryLH's figure of 80-100K to bring a malpractice claim to trial is GROSSLY overstated for all but a few such cases.
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