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Post by Deleted on May 20, 2016 8:08:38 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. This is not surprising and makes perfect sense. Patient sometimes come in demanding an inappropriate test. To assuage the patient, the doctors frequently just order the test or procedure. Then the physician is stuck with acting on that test.
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Post by Deleted on May 20, 2016 8:36:38 GMT -5
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. I disagree with you Dan. I used to be an expert medical witness in malpractice cases (mostly for the defense). Most of the cases that come to trial are complex and usually require more than one expert. Sometime forensic experts are needed as well. You also need experts to estimate loss of earnings, future functional disability, etc. Consider this, most experts get at least $500 per hour. They get paid to review the case, to be deposed and then to testify at trial including preparation for trial. These people have to be brought in to testify and it is very very expensive. Very few of these cases are simple anymore and there are numerous other expenses. There are reams and reams of testimony that have to be transcribed such as interrogatories and depositions and those costs can be extensive. Lawyers are turning down cases unless the injuries are substantial and their estimated return makes it worthwhile. I have never been asked to review a case where the file wasn't 1-2 feet high. As you get to trial the it gets even higher. I can just imagine the expert's bill to review this. As an aside, I have been struck by the number of so called medical experts who submit these enormous bills and then when they testify, it is obvious that they didn't spend much time studying the file as they often don't know the facts of the case.
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Post by Deleted on May 20, 2016 8:37:25 GMT -5
Sorry, my comments should have been directed to goo.gl/al7jpf
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DanMcQ
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Post by DanMcQ on May 20, 2016 8:47:04 GMT -5
JerryLH, any expenditures by plaintiffs attorneys on cases they win are easily offset by those they win - it's the overhead of doing business for those attorneys, not (in general) a cost borne by the plaintiffs. And yes, I have similar experience to yours in the process. There is no question there are 'experts' out there who charge outrageous fees for opinions that are patently wrong. Same observation as yours that some 'experts' bill way more than the effort they actually put in. That's totally dishonest IMO.
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Post by Deleted on May 20, 2016 8:54:11 GMT -5
Agreed Dan. The problem is if they lose, plaintiff's attorneys can get crushed. The plaintiff's don't end of paying their attorney's costs, but can end up getting sued to compensate the defendant attorney's costs. Bottom line-this system sucks.
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DanMcQ
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Post by DanMcQ on May 20, 2016 9:57:54 GMT -5
Bottom line-this system sucks. Not an overstatement.
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EasyEd
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Post by EasyEd on May 20, 2016 13:47:40 GMT -5
One of the biggest costs for health care is insurance, itself. My Irish skin forces me into a dermatologist at least twice a year and I am appalled that, for a four doctor office, there are eight administrators handling calls and filing insurance claims. And, that's just one doctor I go to. In the "good ole days", a patient paid the doctor. Now, we have this large overhead between us and the doctor.
Secondly, if anyone thinks putting medical records onto the computer enhances health care, boy are you wrong.
Also, for those of you who are younger than I, you are in no position to know what is appropriate care for us oldsters. Take your theories about cost-savings and unnecessary tests and - well, you know what you can do with them.
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Post by Deleted on May 20, 2016 19:22:13 GMT -5
Hi Ed I must say that you are totally wrong about everything in your post. In the good ole days, days, patients were dying due to primitive medicine. My father died at age 56 and would have lived to a ripe old age had he been born 50 years later. In the 1950s, medicine was primitive. Why do you think that life expectancy has increased so much??
You said "Secondly, if anyone thinks putting medical records onto the computer enhances health care, boy are you wrong." No Ed it is you who is wrong. Back in the 1950s, doctors simply scribbled a few notes. It was hard to discern what was going on by reading the records. Computers can identify drug-drug interactions, In a second one can determine the treatment of choice for a disease. I guess you want to go back to the days when doctors were giving penicillin shots for colds.
You are totally wrong about unnecessary tests. They are driving up the cost of medical care. These are not theories. In the "good ole days" you didn't have CT scans and MRIs which when ordered appropriately are very useful. There were also no colonoscopies to screen for colon cancer which have been shown to decrease the death rate for this disease.
And by the way, I am a board certified Geriatrician and I can assure you that I do know what is medically better for you.
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Post by HoyaSinceBirth on May 20, 2016 19:56:54 GMT -5
Yeah Electronic Medical Records can't get here soon enough. I cannot read 90% of doctors hand written notes. Super frustrating.
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DanMcQ
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Post by DanMcQ on May 20, 2016 21:20:17 GMT -5
Yeah Electronic Medical Records can't get here soon enough. I cannot read 90% of doctors hand written notes. Super frustrating. Wait until you try to dig through pages of cloned ICU notes. You'll long for the days of handwritten notes (as will the hospitals when they get fined for too many notes that just copy day after day after day). EMRs are in large part just glorified billing programs despite the advantages Jerry correctly identifies.
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EasyEd
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Post by EasyEd on May 21, 2016 12:55:27 GMT -5
I get awfully scared when I hear physicians quote studies that show performing tests might not result in increased benefits. These are statistical studies and should not be used by medical practitioners in deciding not to order a test. I am a human, not a statistic.
I get equally scared when I hear that cost is an important factor in making medical decisions. I want my physician to order those tests or referrals he/she believes are in my best interest and to tell me why. I can then agree or not. If you are a certified board Geriatician and hold such a passion for cost cutting and say you know what’s best for me, I ain’t goin’ to you.
As for computerized medical records, my wife and I go to more than one physician and seldom do their records interact. One doctor does not have access to the other’s database. They are often on separate systems completely. Recently a cardiologist told me he started out as a doctor and now is a data entry clerk. Another doctor came in to examine my wife’s back and brought with him a “recorder” whose sole job was to enter data on his iPad. My nurse offspring complains that in hospital care they used to have charts in folders at the foot of the bed but now they have to spend time going to the computer to pull up records.
My earlier post about the “good ole days” referred only to the cost of the insertion of insurance between the patient and the doctor. I said nothing about the “good ole days” being superior in medical care. I’m old but not stupid.
I also note that one of the major causes of health care cost increases over the years is increased specialization. Not knocking it, just saying it costs $’s big time.
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hoyainspirit
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Post by hoyainspirit on May 21, 2016 13:42:19 GMT -5
Ed, you need to speak with your physicians. EHRs provide measurement of what are called Meaningful Use Objectives, two of which are: 1)Health Information Exchange; and 2)Medication Reconciliation. While the required targets are modest, physicians do have the ability to and should be reconciling medications and providing electronically a summary of care record for each transition of care or referral. Further, physicians should provide patients with the ability to view online, download, and transmit their health information within four days of the information being available to the doctor. The squeaky wheel gets the oil. Inquire with your health care providers about these issues.
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Post by HoyaSinceBirth on May 21, 2016 14:20:50 GMT -5
The lack of communication between EMRs is one area where a single payer system would be far superior. That's the best thing about the VA system. You can go to any VA in the country and they have access to all your records from any VA hospital you visited. It would be of great benefit if everyone was required to have the same EMR. Unfortunately 1) no EMR is perfect they all have flaws so how do you go about picking which one everyone should use and 2) darn free market I doubt people would be able to push through mandating all health care providers use the same system.
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TC
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Post by TC on May 21, 2016 17:36:16 GMT -5
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. The demographics are baked in that labor force participation is going to decline for the next decade, no matter who's President, no matter how good the economy is. Using it as an economic measure is simply dishonest. It doesn't show you anything at this point other than old people are retiring. If you want to use the age-banded 25-54 figure, that's a bit better, but that's been increasing since 2010. If Mitt Romney had been President for the last 4 years, all we would be hearing about was how good this economy is. Obama has every right to trumpet how things have gone.
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hoyainspirit
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Post by hoyainspirit on May 22, 2016 14:26:00 GMT -5
That participation rate argument is just the latest GOP attempt at spin and obfuscation, since they really have no credible argument re: the economy.
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TC
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Post by TC on May 23, 2016 8:50:38 GMT -5
One of the biggest costs for health care is insurance, itself. My Irish skin forces me into a dermatologist at least twice a year and I am appalled that, for a four doctor office, there are eight administrators handling calls and filing insurance claims. And, that's just one doctor I go to. In the "good ole days", a patient paid the doctor. Now, we have this large overhead between us and the doctor. You've just made the argument for single payer.
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EasyEd
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Post by EasyEd on May 23, 2016 9:48:14 GMT -5
TC, actually I made the argument against the current situation with its Obamacare and executive edicts. But, if I had to choose between the current system and a single payer system, I'd might, reluctantly, choose the single payer. My experience with single payer Medicare is that it is administered quite well in that I go to a health care provider and they bill Medicare and Medicare reimburses them. But, I hate the non-administrative parts such as what's included and not included in the coverage. Every year things get added in based on the political views of whatever administration is in power. Likewise, restrictions are inserted for whatever reason the administration decides, such as how many of what sort of test in a given period are covered.
On the other hand the VA system is a mess and is certainly not well administered.
Obamacare gave dictatory power to the Federal government and single payer gives it even greater control and that scares the hell out of me. Make no mistake about it, death panels are coming. Justice Roberts will never get off my $hit list.
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Post by Deleted on May 23, 2016 11:36:18 GMT -5
Hi ED!!
The attack on the VA is politically inspired. It is better administered than the private sector and the care there as well as access is much better than in the private sector.
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Post by HoyaSinceBirth on May 23, 2016 21:12:13 GMT -5
I haven't had the chance to work in the VA and my only knowledge I have is from friends and family who have worked at the DC VA. The DC VA is voted the worst VA in the country but I have heard horror stories about the VA from them (mostly about the nurses(because the VA spends so much money taking care of patients they cut back everywhere else including hiring nurses that are grossly unqualified and incompetent from what I've been told). That said other attendings I've talked to who have experience outside of DC all love the VA and think it's a great place to practice probably because the access and care is very good(although extremely costly).
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kchoya
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Post by kchoya on May 23, 2016 23:48:24 GMT -5
Hi ED!! The attack on the VA is politically inspired. It is better administered than the private sector and the care there as well as access is much better than in the private sector. What VA facilities have you worked in recently? Sadly, my experience is that the care there is not better than in non-VA facilities.
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