OT: Surgeon Costs

[buddybikes]

I had single level MIS fusion of L4 L5 month ago, doing great. I can actually reach my handlebars, but can't ride for another couple months. Interestly I saw the billing and payments for my surgeon. His billed rate was 19,000 but insurance paid him $5,500. This for a 5 hour surgery. $1,100 hr billing rate for such surgery seems quite reasonable to me, kind of saving my life (at least functionally). High end lawyers make this easily and are they doing such human benefit? More of a comment than question...

[thwart]

Yep, I'd agree that $5500 seems reasonable.

$19,000... probably not.

And yet, if you don't have health insurance (where the companies negotiate that outrageous billed rate down)... guess what you pay?

[ultraman6970]

My wife gor two surgeries last year and what sucks the most is that bills for M -O- F- OS you haven't heard before arrives sometimes. But yeah.. surgeons charge a lot but they have to pay a lot of insurance too.

[jimcav]

I had single level MIS fusion of L4 L5 month ago, doing great. I can actually reach my handlebars, but can't ride for another couple months. Interestly I saw the billing and payments for my surgeon. His billed rate was 19,000 but insurance paid him $5,500. This for a 5 hour surgery. $1,100 hr billing rate for such surgery seems quite reasonable to me, kind of saving my life (at least functionally). High end lawyers make this easily and are they doing such human benefit? More of a comment than question...

my MTF's asshat gatekeeper refused to release me to the network despite clear referral from the head of orthopedics. i had to pay cash, no insurance, and the i paid really low fraction 8th of the "billable" cost. seems crazy the mark-up that insurance does pay--maybe i got lucky, i certainly worked to get the best deal i could

[bigbill]

I had a L5-S1 Micro-discectomy in November. The bill was just under $30K for a 40 minute procedure. The doctor was out of network but there was nothing comparable in network using my BCBS PPO. BCBS paid about half of that with my military retirement (Tricare) picking up the co-pays.

On the medical side, I had the surgery on a Wednesday, and went for a two block walk on Saturday. I took 10 days off work but I'm an engineer, my back doesn't make my living. If I worked in a more physical job, I would have needed more time off. I worked my way to 4 miles walks before getting on the bike at the 6 week point. I've ridden about 250 miles since 12/28. My back is sore and I have some muscle spasms, but no sciatic pain or numbness. It will likely be several more months before I'm pain free.

[batman1425]

Assuming that is the itemized for just the surgeon and not the total procedure? If so, that hourly doesn't all go to the Doc. Hospital takes a bite, insurance, etc. Some of that will cover his involvement in postoperative care as well. If that is total cost, that's a flat out steal when you factor in anesthesia, recovery time, etc.

MLWs appendectomy 2 years ago was 24K all in for the diagnostics, procedure, and recovery. From start to finish the entire process took 23 hours from walking in the door of the ED to Discharge. Actual procedure time was about 60min.

The pricing structure is misleading because the numbers are inflated to net a payout that is closer to what it actually costs to do the procedure. Claim > insurance payout > actual procedure cost. Providers know they won't get the full amount of almost any claim submitted.

[buddybikes]

This was just the surgeon. Hospital bill was 49K (forgot what actual was) plus pre-adminition, xrays and such. Fortunately (or unfortunately) our deductable was fulfilled so my payment was zero.

5 weeks out, walking least few miles a day plus walking in the water for 20 min time, so I pleased with progress. Pain in lower back on bike machine, but way too soon for that, need to get some core strength up. Dr said no exertion for 3 mos

[93legendti]

Nothing to add about the cost side, but I just got back from visiting a dear friend who fractured L4 on Tuesday, due to multiple myeloma. Thursday night they cemented the fracture and today he is moving around like nothing happened. Yesterday he was moving a bit gingerly...1/2 hr surgery, but I doubt he will complain about the bill...well, maybe a little.

[JasonF]

Very reasonable. I'm friends with quite a few surgeons (orthos, general, GI, etc...) and they bemoan the fact that they get squeezed by insurers, Medicare, etc, etc...and they'll confide that their business is morphing into a volume-based business to keep revenue high.

On the flipside, my daughter has been battling a severe ulcerative colitis flare for a couple months now and has been in 3 hospitals: 2 in LA, 1 in Philly and the LA GI was amazing. He spent tons of time with her and I was shocked when I got the EOB from my insurer: they paid him $300 and I'm on the hook for another $360. It's depressing to think he'll only earn $660 for all his efforts.

[oldpotatoe]

In 2002 I spent 5 days in hospital after being hit by a car(actually P/U truck) while riding. No real treatment other than being fitted for a back brace. Observation and about 12 trips to imaging...$44,000...

Just spent last Sunday, Monday and Tuesday in hospital....PE.....alls well that ends well..happy 65th birthday and crisp new medicare card..we'll see how that goes.

[buddybikes]

Jason - I fully agree - our daughter has UC (2.5 years) had C-diff you name it. Her gastro guy was phenominal, calling her at 9pm on occasion. His bill reinbursement was dirt cheap. Good luck with her, UC sucks... Our daughter just got go DVT due to anemia (and perhaps estrogen) from Christmas flight.

[Steve in SLO]

In this case, your surgeon was probably contracted to the insurer for a percentage of billed charges, in this case he received 29%.
Where I work, our overall collection is approximately 22 to 26% of billed charges, between government and third-party payers.
This percentage can vary greatly depending on your contracting and geographic location.
In the end, it is just a weird shell game that puts a lot of money into the wrong pockets, IMHO.

[numbskull]

Just spent last Sunday, Monday and Tuesday in hospital....PE......

Sorry to hear this!
Did they determine a cause?

[oldpotatoe]

Sorry to hear this!
Did they determine a cause?

Tore MCL in right leg about 2010, BIG swelling, no DVT at the time but..venus stasis, swelled leg.foot. Compression sock but stopped after sold shop in 2013...ultra sound in hospital showed 2 DVT in right leg..so..heparin, then Lovenox(4 shots)now compression sock and Eliquis for the forseeable future. Just had shortness of breath, panting with everyday stuff. Rode the Tuesday before and couldn't catch breath. BUT dodged bullet no doubt. GREAT staff at Boulder Community..excellent.

Not recommended tho...:rolleyes:

[wpod]

Let me begin by saying i'm very glad to hear your up, around and making good progress towards a full recovery.

In my mind, many of the pricing issues mentioned above can be attributed to collusion within the insurance and health care industries and are a total SCAM which should be remedied and outlawed and/or ideally criminalized.

The health care providers ( hospital/pharma/medical industry ) generate billingss at outrageous and uncontrolled rates to maximize the co$t base for their partners in crime and masters- the insurance carriers.

Those inflated and excessive costs are then used as the insurance industry's expense basis in calculating premiums for policy holders vs. the actual NET amount billed to and paid by the carrier. Premiums based upon those obscene, non discounted costs are why insurance premiums continue to rise year after year, far exceeding any other business sector and crippling the US economy. The health care industry establishes "preexisting arrangements, contracts & pricing in place" for their services with the insurance industry, providing those carriers a massive discount on the entire billing. Discounts which individuals, aka the uninsured can never, ever receive even when paying in full when services are rendered. The insurance carriers pay quarters on the dollar while maximizing their expense basis at an inflated rate thereby maximizing profit swindled from us.

Ever notice how many hospitals are now owned/controlled by insurance related corporations?

In my humble opinion this is the core of our bloated, predatory and horrendous health care crisis.

[firerescuefin]

Point of reference

Had a 2 level lumbar disc replacement done in Munich Germany, by the best surgeon in the word (at that particular surgery).

Total cost (all in including follow ups)...We paid out of pocket 29K (and were later reimbursed for most, thankfully). My experience at the clinic in Munich was a 10/10 across the board.

[GScot]

Percentage payment is unpredictable. I racked up nearly six figures billed from a broken elbow last July, insurance paid about 30k I think as everything is not settled quite yet. It was 5 surgeries as they put a new end on the radius and a plate on the ulna. Then a drug resistant infection led to a hospital stay with two debridement surgeries and later moving some muscle strands to the wound that refused to heal following the infection. Topped that off with another surgery to remove scar tissue in an effort to get the joint moving. Anyway looking at billing the payment percentage seems almost random. One surgery the anesthesia was paid at 20%, another time 70%.

[bigbill]

Nothing to add about the cost side, but I just got back from visiting a dear friend who fractured L4 on Tuesday, due to multiple myeloma. Thursday night they cemented the fracture and today he is moving around like nothing happened. Yesterday he was moving a bit gingerly...1/2 hr surgery, but I doubt he will complain about the bill...well, maybe a little.

I have a friend at work who is a cyclist. His wife had been battling cancer for a few years and passed away last spring. After her death, he had time to address his issues and had both knees replaced. He was doing well, up and walking with canes in a few days. He had a walker at home so he could do things that required standing. He fell and landed on his walker fracturing two vertebrae. The amazing part was that he had surgery that cemented the fractured vertebrae and was back at work in three days. I remember when surgery like that had months of recovery.

[sg8357]

In the end, it is just a weird shell game that puts a lot of money into the wrong pockets, IMHO.

I don't think the Insurance company shareholders and your local Hospital
cartel share your opinion.

[eddief]

I dare say David Kirk probably has the smarts and hands to do surgery. He chose metal work and probably did not matriculate in med school for 12 years. Surgery not rocket science, just connected to our life, blood, and guts. Of course, single payer without the phucking insurance companies is the answer. (Bernie)

"Single-payer national health insurance, also known as medicare for all, is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

The program would be funded by the savings obtained from replacing today's inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care."

[93legendti]

I have a friend at work who is a cyclist. His wife had been battling cancer for a few years and passed away last spring. After her death, he had time to address his issues and had both knees replaced. He was doing well, up and walking with canes in a few days. He had a walker at home so he could do things that required standing. He fell and landed on his walker fracturing two vertebrae. The amazing part was that he had surgery that cemented the fractured vertebrae and was back at work in three days. I remember when surgery like that had months of recovery.

Sounds like your friend has had a rough couple of years...


I am so happy for my friend (at least because of the back surgery), because his son's bar mitzvah is next week. He is supposed to come home Sunday, which would be 3 days since the surgery. I agree, truly amazing.
Hopefully, the prognosis of his myeloma will be as positive.

[makoti]

Yep, I'd agree that $5500 seems reasonable.

$19,000... probably not.

And yet, if you don't have health insurance (where the companies negotiate that outrageous billed rate down)... guess what you pay?

Less than $19k. Likely about 35% less. Still a lot, to be sure.

[oldpotatoe]

I dare say David Kirk probably has the smarts and hands to do surgery. He chose metal work and probably did not matriculate in med school for 12 years. Surgery not rocket science, just connected to our life, blood, and guts. Of course, single payer without the phucking insurance companies is the answer. (Bernie)

"Single-payer national health insurance, also known as medicare for all, is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

The program would be funded by the savings obtained from replacing today's inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care."

Huzzah!!! BUT far to many legislators are being bribed by big Pharma, Big Medical Insurance, for this to happen. I was on TriCare now medicare and talking to the people in the hospital, docs to nurses aides, they all say it works very, very well.

Kinda like Canyon bikes going direct.

[93legendti]

I think it would be better to outlaw drug companies and hospitals that make a profit and cap dr salaries at $75,000.

[bigbill]

I was on TriCare now medicare and talking to the people in the hospital, docs to nurses aides, they all say it works very, very well.

Kinda like Canyon bikes going direct.

That's me in 14 years. I'm also in the VA system. I've spoken to my Congressman a few times about changing the system for people like me to have VA pay my co-pay in the Medicare system for service related medical care to free up capacity in the VA system.

I would hope a single payer system as good as Medicare could ramp up and cover Americans. For now we have the murky VA system as an example.

[Walter]

Lots of blame to go around to many for unreal health care cost. Example: Legislation that does not allow Medicare to negotiate Rx drug prices. Thus, Medicare pays way more to big pharma than do other patients. Whose pockets got lined for those votes...

I had a spinal fusion 4 years ago at a pre-eminent facility. 3 nights in the hospital and the bill was $255K! The surgeon, who toiled on my spine for 10 hours addressing a complication he found after I was opened up, billed a fraction of that.

Ins co paid less than 1/2 to the hospital due to the contacted rate.

BTW: I have had a great result...principally due to the skill, experience and never quit attitude of my surgeon.

[PQJ]

I think it would be better to outlaw drug companies and hospitals that make a profit and cap dr salaries at $75,000.

It doesn't have to be that draconian. Just get rid of health insurance companies and introduce reasonable, common-sense regulations that prohibit drug companies from rapacious price gouging.
I am friendly with many medical doctors, not a few of whom routinely lament how "Obamacare" has destroyed their livelihood. Which is odd, because their Maseratis, mansions, and vacations in Hawaii and other exotic locales tend to suggest otherwise.

[ldamelio]

I think it would be better to outlaw drug companies and hospitals that make a profit and cap dr salaries at $75,000.

Yep. Top of your class in high school. Four years in a strong university at the top of your class. Four years of medical school. Four to eight years of postdoctoral training at 80 hours a week (used to be 90-130 before reforms). Making your first dollar at age 33- 35 after having spent $200,000 to $600,000 on your education. Malpractice insurance costing between $30,000 and $250,000 per year depending on specialty and location. Office rent, staff salaries and benefits to be paid. Lots of bright young people will sign up for your proposed deal.

[jc031699]

Yep, I'd agree that $5500 seems reasonable.

$19,000... probably not.

And yet, if you don't have health insurance (where the companies negotiate that outrageous billed rate down)... guess what you pay?

That "outrageous billed rate" has no basis in reality and probably has more to do with the accounting when a patient CANNOT pay. No cost transparency. Would you take your car in for service if they told you, no idea how much it will cost but you need it. You might end up paying somewhere between $2500 and $9500? (Halved the numbers to make them more likely for a car.)

[jc031699]

my MTF's asshat gatekeeper refused to release me to the network despite clear referral from the head of orthopedics. i had to pay cash, no insurance, and the i paid really low fraction 8th of the "billable" cost. seems crazy the mark-up that insurance does pay--maybe i got lucky, i certainly worked to get the best deal i could

That is usually the case. There is an adjusted rate for self-pay, not necessarily that much of a discount though.

[firerescuefin]

Yep. Top of your class in high school. Four years in a strong university at the top of your class. Four years of medical school. Four to eight years of postdoctoral training at 80 hours a week (used to be 90-130 before reforms). Making your first dollar at age 33- 35 after having spent $200,000 to $600,000 on your education. Malpractice insurance costing between $30,000 and $250,000 per year depending on specialty and location. Office rent, staff salaries and benefits to be paid. Lots of bright young people will sign up for your proposed deal.

His post was pure sarcasm.

Which is odd, because their Maseratis, mansions, and vacations in Hawaii and other exotic locales tend to suggest otherwise.

I also have quite a few friends who are docs. None drive Maseratis or own mansions...though some have vacationed in nice spots, have kids in private schools, and driver newer cars (The nerve).

After 4 years of pre med, 4 years of medical school, and another 4-8 years of internships/fellowships, I'd neither want their lives nor their debt...nor harbor any ill will against their success (which is grossly overstated in many cases, by folks like yourself).

[jc031699]

In 2002 I spent 5 days in hospital after being hit by a car(actually P/U truck) while riding. No real treatment other than being fitted for a back brace. Observation and about 12 trips to imaging...$44,000...

Just spent last Sunday, Monday and Tuesday in hospital....PE.....alls well that ends well..happy 65th birthday and crisp new medicare card..we'll see how that goes.

Sorry to hear, Peter. Hope you're okay.

[oldpotatoe]

Sorry to hear, Peter. Hope you're okay.

Doin ok, maybe ride tomorrow.

[ldamelio]

I apologize if I missed the sarcasm. As you probably inferred, I'm a surgeon. I make a good living and have no complaints, but it's not extravagant or remotely proportional to what I've missed in life. I'm the first one to say that the current system is beyond broken. There is an incredible amount of byzantine cost shifting to make it all 'work.' Single payer with reasonable reimbursements to providers would solve it all. Sadly, it will never happen. The middle man (insurance industry) eats up most of the health care dollar that could be put towards prevention and care or simply saved and used for other societal imperatives (education, hunger, homelessness, etc.) A powerful lobby like this will never be overcome.

[PQJ]

His post was pure sarcasm.



I also have quite a few friends who are docs. None drive Maseratis or own mansions...though some have vacationed in nice spots, have kids in private schools, and driver newer cars (The nerve).

After 4 years of pre med, 4 years of medical school, and another 4-8 years of internships/fellowships, I'd neither want their lives nor their debt...nor harbor any ill will against their success (which is grossly overstated in many cases, by folks like yourself).

Easy there, fella. I harbor no ill will of any kind against any doctor I know, nor do I begrudge them any of their success. They ought to be well compensated for the work they do and the sacrifices they've made to get where they are. I think you are missing the point of my post.

[firerescuefin]

Easy there, fella. I harbor no ill will of any kind against any doctor I know, nor do I begrudge them any of their success. They ought to be well compensated for the work they do and the sacrifices they've made to get where they are. I think you are missing the point of my post.

Ok...I'll admit to missing your point ...and that point is? (no sarcasm inserted)

[soulspinner]

My daughter had a 4 hole appendectomy. Hospital charged us 2 dollars for water(tap) to take our own Tylenol(not dispensed by them). Really?:butt:

[JasonF]

I apologize if I missed the sarcasm. As you probably inferred, I'm a surgeon. I make a good living and have no complaints, but it's not extravagant or remotely proportional to what I've missed in life.

Spoken from a guy in the trenches. As noted above, I have many friends who are docs & surgeons and it's a very hard life and whatever income they make pales in comparison to the sacrifices they have endured. At a certain point, many feel that they've earned the right to a certain lifestyle (million dollar plus homes, private schools, country club memberships, etc, etc...) and carry an incredible amount of debt that has accrued to support the lifestyle. Banks are happy to lend to them (especially if they own their practice and facilities) as it allows them to provide financing to the practice, etc...Plus docs typically have recession-proof stable incomes. I have nothing but the utmost respect to any doctor I've met - the calling can be a hard one.

[jc031699]

Let me begin by saying i'm very glad to hear your up, around and making good progress towards a full recovery.

In my mind, many of the pricing issues mentioned above can be attributed to collusion within the insurance and health care industries and are a total SCAM which should be remedied and outlawed and/or ideally criminalized.

The health care providers ( hospital/pharma/medical industry ) generate billingss at outrageous and uncontrolled rates to maximize the co$t base for their partners in crime and masters- the insurance carriers.

Those inflated and excessive costs are then used as the insurance industry's expense basis in calculating premiums for policy holders vs. the actual NET amount billed to and paid by the carrier. Premiums based upon those obscene, non discounted costs are why insurance premiums continue to rise year after year, far exceeding any other business sector and crippling the US economy. The health care industry establishes "preexisting arrangements, contracts & pricing in place" for their services with the insurance industry, providing those carriers a massive discount on the entire billing. Discounts which individuals, aka the uninsured can never, ever receive even when paying in full when services are rendered. The insurance carriers pay quarters on the dollar while maximizing their expense basis at an inflated rate thereby maximizing profit swindled from us.

Ever notice how many hospitals are now owned/controlled by insurance related corporations?

In my humble opinion this is the core of our bloated, predatory and horrendous health care crisis.

I think you give the players a bit too much credit for nefarious intent. It is a bloated and unwieldy system for sure, but there is an enormous amount of inertia and history behind how this came about, and none of the entities has much real impact on changing the system. (Why this has to be reformed through legislation. Good luck with that.) Of course everyone is trying to maximize their benefits from the "market", but that is how a capitalist system is set up. If you think healthcare in general should be subjected to a different standard than capitalism, with its inherent conflicts, that is an entirely separate discussion.

And price transparency to the consumer is critical to an efficient marketplace, which is basically lacking as it currently stands.

[buddybikes]

Also in hospital had a "diabetes specialst" come see me for 5 minutes, asked few dumb questions to see if I knew how to manage myself, and left. No detailed discussions of basal/bolus rates after surgery nothing, she billed 503.00 think her adjusted rate was 130 which was still bull ····. My diabetes specialist mat make 200 on me after a complete discussion and analysis of 3 mos worth of blood sugar trends, review blood panel, write scripts and look at current med problems.

[OtayBW]

My daughter had a 4 hole appendectomy. Hospital charged us 2 dollars for water(tap) to take our own Tylenol(not dispensed by them). Really?:butt:
I would write a letter to the hosptal administrator, the insurer, the editorial staff of the local newspaper and TV stations, my state and congressional legislators and anybody else willing to listen. That is insane!

[jc031699]

My daughter had a 4 hole appendectomy. Hospital charged us 2 dollars for water(tap) to take our own Tylenol(not dispensed by them). Really?:butt:

Most restaurants charge a corkage fee too. Life is not just...

[etu]

Also in hospital had a "diabetes specialst" come see me for 5 minutes, asked few dumb questions to see if I knew how to manage myself, and left. No detailed discussions of basal/bolus rates after surgery nothing, she billed 503.00 think her adjusted rate was 130 which was still bull ï½·ï½·ï½·ï½·. My diabetes specialist mat make 200 on me after a complete discussion and analysis of 3 mos worth of blood sugar trends, review blood panel, write scripts and look at current med problems.

seems like highway robbery at first glance, but 5-10 minutes to review your history, another 5-10 minutes to writer her consultation note and perhaps a discussion with the primary inpatient team...

[bigbill]

I didn't support ACA because I just saw it as a delayed path to single payer. If the intent is single payer, just do it. What we got was a failure to address high costs of healthcare by creating a system to pay the existing costs. So much of our economy is healthcare and insurance, I don't see how we get out of this hole we created. ACA is supposed to create competition in the marketplace to drive down costs, I'd like to see that work.

My back surgeon is one of best in the country, his rates are high but he gets more than half of what he charges from the insurance company. He and his partners also own the hospital which specializes in spinal surgery and joint replacement. It was like checking into a Hilton and having surgery. But again, the insurance company pays.

[thwart]

Doin ok, maybe ride tomorrow.

Blood thinners... ride safe... and tighten the straps on that helmet. ;)

[onekgguy]

Blood thinners... ride safe... and tighten the straps on that helmet. ;)

Yes, not something to take lightly. I had my first round of PEs 4 years ago. I was on Coumadin for 1 year then came off of it only to find myself back in the hospital for 4 nights one year ago with numerous clots in addition to more PEs. I came very close to losing my left leg at the knee due to a clot behind my knee in my popliteal artery. I have Factor V Leiden, something I would guess they checked you for (Oldpotatoe) but make sure. I'm happy to be on thinners the rest of my life and minimize the chance of having to go through all that again.

Kevin g

[scrubadub]

<RANT>
I'm sure we could come up with endless examples of (sometimes) egregious costs to the patient. But often there's a rationale for the costs. For example, if you take your own meds they still need to be approved by the physician, confirmed by the pharmacist, and accounted for by the nurse. Hence why inpatient meds, even your own, cost more.

A lot of people begrudge physician salaries for some reason. Heck, a lot of people begrudge other people's salaries without really knowing what goes into their time. Honestly, I think most professional salaries are actually quite reasonable for what you get. How much do you think your surgeon is worth?

Most physicians I know are not rolling in money and the ones I do know work their butts off for it. Yes, one of our cardiac surgeons drives a McLaren but he is there ALL THE TIME operating and taking care of his patients. Yes, the GI guy drives an R8, but he will come in any time, any day, to do that ERCP or stent instead of punting it off to some lesser-skilled colleague.

I think it's telling that at my old medical school, 20-30% of medical students per year are choosing not to do residency and go into medical practice. Instead they work for tech or pharma. Why? Probably because they get paid and treated better. And I've seen some of the most talented surgeons and physicians get burned out and leave for those same industries for the same reasons.

But the real problem isn't the physician or other professional charges. If you don't fix the high overhead imposed by our current payer system then we will never bend the cost curve. And that's not even accounting for all the time we have to spend fighting to get patients the right treatment.
</RANT>

[thwart]

I didn't support ACA because I just saw it as a delayed path to single payer. If the intent is single payer, just do it.

If you're trying to get over a 10 foot concrete wall, sometimes you need to use steps. Just can't possibly do it in one big jump.

And sometimes you settle for a first big step that's designed and constructed by committee and doesn't work nearly as well as it should.

[buddybikes]

Great discussion here, especially the MD's chiming in. Sad that this knowledge can't get through the thick skulls running for president, you would think Carlson would have the insight, rather than "savings accounts".

Regarding my diabetes care, I didn't have a hospitalist and I was totally managing my blood sugar with my pump (from 2 hrs after surgery) and self monitors. Nurses checked bs few times a day but then just left no matter what the reading.

[etu]

<RANT>
I'm sure we could come up with endless examples of (sometimes) egregious costs to the patient. But often there's a rationale for the costs. For example, if you take your own meds they still need to be approved by the physician, confirmed by the pharmacist, and accounted for by the nurse. Hence why inpatient meds, even your own, cost more.

A lot of people begrudge physician salaries for some reason. Heck, a lot of people begrudge other people's salaries without really knowing what goes into their time. Honestly, I think most professional salaries are actually quite reasonable for what you get. How much do you think your surgeon is worth?

Most physicians I know are not rolling in money and the ones I do know work their butts off for it. Yes, one of our cardiac surgeons drives a McLaren but he is there ALL THE TIME operating and taking care of his patients. Yes, the GI guy drives an R8, but he will come in any time, any day, to do that ERCP or stent instead of punting it off to some lesser-skilled colleague.

I think it's telling that at my old medical school, 20-30% of medical students per year are choosing not to do residency and go into medical practice. Instead they work for tech or pharma. Why? Probably because they get paid and treated better. And I've seen some of the most talented surgeons and physicians get burned out and leave for those same industries for the same reasons.

But the real problem isn't the physician or other professional charges. If you don't fix the high overhead imposed by our current payer system then we will never bend the cost curve. And that's not even accounting for all the time we have to spend fighting to get patients the right treatment.
</RANT>

1+
Hey Scrub,
Do I know you?
Parnassus?
California?
Divisadero?

[scrubadub]

1+

Hey Scrub,

Do I know you?

Parnassus?

California?

Divisadero?


I'm farther south at Stanford but finishing up and heading to Minnesota next year.

[bigbill]

One of the happiest doctors I ever met was when I was in the Navy. A 55 year old Cardiologist who had quit his practice a few years prior and joined the Navy through a special program. He came in as an O-6 (Navy Captain) after a short indoctrination program. He didn't have to have malpractice insurance, no overhead, guaranteed patient inflow, no long hours, no partnerships, and a reserved parking spot. I saw him after my MI in 2011 we sat down over a cup of coffee and went through all my records after my exam. He told me to not give the MI another thought, just live my life. If you've seen Office Space, he was Peter Gibbons post hypnosis.

[etu]

I'm farther south at Stanford but finishing up and heading to Minnesota next year.

Nice. Some good riding out in the Twin Cities area.

[batman1425]

I think it would be better to outlaw drug companies and hospitals that make a profit and cap dr salaries at $75,000.

As someone already mentioned - major student debt accrued for the training. 20-250k for undergrad, 200-500K for med school. Resident salary of 50-70k/yr. If you want to specialize - residency could be 7+ years - with those student loans compiling massive interest the whole time. For some folks, they could be looking at close to 1M in debt by the time they get out of residency. 350-400k a year doesn't sound so unrealistic when you factor in that debt and the operating costs of being a physician (insurance, etc.)

The financial burden associated with being a doc is already reducing the number of people that go into medicine - especially in the family practice, pediatrics, internal med, and infectious disease specialities, because of the low (comparative) salaries. Paying back all that money on 200k/yr while got forbid trying to start a family or own a home is a seriously hard task that takes careful planning and far from extravagant living. The sterotypical country club doctor is not representative of the vast majority of docs in this country.

If you want to putting a cap on salaries the training needs to be free (or next to).

[oldpotatoe]

Yes, not something to take lightly. I had my first round of PEs 4 years ago. I was on Coumadin for 1 year then came off of it only to find myself back in the hospital for 4 nights one year ago with numerous clots in addition to more PEs. I came very close to losing my left leg at the knee due to a clot behind my knee in my popliteal artery. I have Factor V Leiden, something I would guess they checked you for (Oldpotatoe) but make sure. I'm happy to be on thinners the rest of my life and minimize the chance of having to go through all that again.

Kevin g

Blood test for the Factor V thing and also protein C or S abnormality. Eliquis...I also had a clot in right leg in popliteal artery. Smaller one in femoral.

[eddief]

If doctors don't like it as a group, why don't they get together and make some damn noise. Just another set of Americans (me too) that has been pacified into accepting the status quo. I wonder who owns the AMA? Oh, they only have 230,000 members.

http://www.fiercehealthpayer.com/story/top-health-insurance-ceo-pay-exceeds-10-million

[batman1425]

If doctors don't like it as a group, why don't they get together and make some damn noise. Just another set of Americans (me too) that has been pacified into accepting the status quo. I wonder who owns the AMA? Oh, they only have 230,000 members.

http://www.fiercehealthpayer.com/story/top-health-insurance-ceo-pay-exceeds-10-million

And when are they going to have time to do that exactly? How many docs do you know with the free time to start a lobbyist movement? Would you propose they strike or slow down instead? How many patents will suffer because of that?

[scrubadub]

If doctors don't like it as a group, why don't they get together and make some damn noise. Just another set of Americans (me too) that has been pacified into accepting the status quo. I wonder who owns the AMA? Oh, they only have 230,000 members.



http://www.fiercehealthpayer.com/story/top-health-insurance-ceo-pay-exceeds-10-million


Many of us do just that, working from both inside and outside the system to make things better. We even have PACs, lobbyists, and think tanks like every other field. As alluded to before, the American health care system, as with many other things, is complex and has many of its best and worst parts deeply rooted in history.

But just because things are not perfect now doesn't mean that progress hasn't been made nor that things won't or can't be better.

I had the benefit of studying under some health economists in South Africa after apartheid collapsed. Even though they had (to some extent) a cleaner slate than say we do, change there was and still is slow. Even if we could snap our fingers and reinvent the US health care system overnight, there would be unexpected problems and consequences that would need to be fixed. Same with those who complain about the tax code, intellectual property, etc.

[eddief]

while they are suffering at their jobs. Kick some butt through the AMA. I am sure bought and sold by pharma and insurance. Please don't tell me doctors are victims.

And when are they going to have time to do that exactly? How many docs do you know with the free time to start a lobbyist movement? Would you propose they strike or slow down instead? How many patents will suffer because of that?

[jc031699]

while they are suffering at their jobs. Kick some butt through the AMA. I am sure bought and sold by pharma and insurance. Please don't tell me doctors are victims.
~~~~~~~~~~~
If doctors don't like it as a group, why don't they get together and make some damn noise. Just another set of Americans (me too) that has been pacified into accepting the status quo.

Yes, and take everything you just said and replace "doctors" with the word "patients". There are far more of them than doctors. This is a complex problem, and simplistic views don't really help the conversation very much.

[eddief]

but the people THEY elected would not vote for it. I wonder if it isn't simpler than you think? If the majority of the patients want it and the majority of doctors want it, what's really getting in the way?

Yes, and take everything you just said and replace "doctors" with the word "patients". There are far more of them than doctors. This is a complex problem, and simplistic views don't really help the conversation very much.

[oldpotatoe]

but the people THEY elected would not vote for it. I wonder if it isn't simpler than you think? If the majority of the patients want it and the majority of doctors want it, what's really getting in the way?

That's easy-via 'contributions', aka bribes.

[eddief]

why can't we be reasonable?

http://qz.com/596811/this-is-bernie-sanderss-universal-healthcare-plan-for-every-american/

[SlackMan]

why can't we be reasonable?

http://qz.com/596811/this-is-bernie-sanderss-universal-healthcare-plan-for-every-american/

It's not a clearly better idea. See the article below that explains some of the problems with Canada's system. A telling quote:

"Defenders of Canadian Medicare trumpet the fact that no one is ever denied care in Canada. But the question of timely treatment has become a thorny one.

Just ask the nearly 42,000 people who sought and paid for treatment outside Canada last year. Many of those people go to the United States because their cases are considered non-urgent. Pain, suffering and quality of life don't count when it comes to determining location in the queue."

Click here: Long Canadian wait times send patients south for surgery. (http://www.calgaryherald.com/news/calgary/Long+Canadian+wait+times+send+patients+south+surge ry+Video/9702357/story.html)

[eddief]

there are 33M people in Canada. last year 42K of those went outside the country for help due to long waits = .12 percent. Wonder how many Americans go outside the country due to the prices here? I'd take the Canada numbers any day. 29M Americans still uninsured. No death panels so far with Bamacare.

"We estimate some 1,200,000 Americans will travel outside the US for medical care this year (2014)."

It's not a clearly better idea. See the article below that explains some of the problems with Canada's system. A telling quote:

"Defenders of Canadian Medicare trumpet the fact that no one is ever denied care in Canada. But the question of timely treatment has become a thorny one.

Just ask the nearly 42,000 people who sought and paid for treatment outside Canada last year. Many of those people go to the United States because their cases are considered non-urgent. Pain, suffering and quality of life don't count when it comes to determining location in the queue."

Click here: Long Canadian wait times send patients south for surgery. (http://www.calgaryherald.com/news/calgary/Long+Canadian+wait+times+send+patients+south+surge ry+Video/9702357/story.html)

[SlackMan]

there are 33M people in Canada. last year 42K of those went outside the country for help due to long waits = .12 percent. Wonder how many Americans go outside the country due to the prices here? I'd take the Canada numbers any day. 29M Americans still uninsured. No death panels so far with Bamacare.

"We estimate some 1,200,000 Americans will travel outside the US for medical care this year (2014)."

Are these Americans traveling outside the US for medical care because of long waits or the unavailability of care in the US? I would be extremely surprised if that were the case. That is a the critical distinction. Traveling outside the US for less expensive plastic surgery or dental care (which many people do) is quite different than traveling outside of Canada because one either cannot get the medical care they want or cannot get that care in a timely fashion.

[eddief]

because either insurance is too expensive to obtain or because even though they have insurance, deductibles and copays are ridiculous.

Are these Americans traveling outside the US for medical care because of long waits or the unavailability of care in the US? I would be extremely surprised if that were the case. That is a the critical distinction. Traveling outside the US for less expensive plastic surgery or dental care (which many people do) is quite different than traveling outside of Canada because one either cannot get the medical care they want or cannot get that care in a timely fashion.

[scrubadub]

Are these Americans traveling outside the US for medical care because of long waits or the unavailability of care in the US? I would be extremely surprised if that were the case. That is a the critical distinction. Traveling outside the US for less expensive plastic surgery or dental care (which many people do) is quite different than traveling outside of Canada because one either cannot get the medical care they want or cannot get that care in a timely fashion.


Many are traveling because even with out of pocket expenses it's cheaper than getting it with insurance here. For example, there are excellent cardiac surgery specialty hospitals in India that will do package deals where your loved ones get a fancy hotel and tours while you are getting surgery and recovering. It depends on your insurance coverage so for some who have not so great coverage this is one way to save money.

[paredown]

Let me say up front that am deeply appreciative of those folks who do the hard work to qualify for surgical specialties--and to those good folks I have met over the years (and others like them) doing the demanding work of caring for the needs of others.

But...

Two years ago I had a fall at work. Only one floor, but I landed on top of debris and was pretty banged up. Packed up my tools, and drove myself to the local Emergency, 'cause that's what real men do.

Abysmal service. Then lots of x-rays of body parts that had only been incidentally banged up--despite me telling them that they were not needed. (CYA, I assume--afraid of lawsuits. Certainly no consumer sovereignty at work.) Then cat scans for my back (possibly needed--that's what hit). Total bill all in was over $24,000 for a couple of hours, and I did not even get help getting out of the hospital despite being in crippling pain from fractured vertebrae and broken ribs.

After insurance, we were out of pocket over $4,000.

Do the math--this represented 200 hours of construction labor for me in the new gig economy of $20/hr work, no benefits etc. So in effect the previous five weeks of work barely covered the copays for one Emergency room visit--despite having insurance.

You want to talk about a grenade-sized hole in a family budget from a relatively minor accident? And this is with an Health Exchange plan that is the best we can buy (Gold)--and that costs us over $750/month for coverage for the two of us.

All I know is that something is seriously broken in the US health care system.

(Oh, and then there was the kick in head later, when the owner/builder unilaterally cut my last invoice in half, because 'she had spent too much on the house.')

[stackie]

I think it would be better to outlaw drug companies and hospitals that make a profit and cap dr salaries at $75,000.

I think that simply capping physician salaries at 75,000 would be enough to solve the financial problems of our medical care system. No one in their right mind would undergo the educational rigors to be a physician, the stress of lives directly in your hands, work at all hours of the night, and ridiculous bureaucracy of the system to work for a salary that would not even cover rent in many areas of the country.

I'm sure you were joking.

If you are not, then we should just salary all Americans at 75,000, from McDonald's to the presidency. Ban all profits for all companies for good measure. I'll take the job at McDonald's. Much easier to sleep at night knowing that if I filled someone's order wrong it no big deal.

Jon

[buddybikes]

paredown's issue is a huge core problem. yes xx million have been added to insured, but with unbearable deductables before kicking in. My family's is 10K, we use it up quickly due to various chronic health issues, which we are able to budget up front (with 2 people working) and assume 10K is gone.

Only thing I can suggest to people, is just that, budget your max out of pocket as assumed loss. If it is a good year, then you have that money for other purposes.

Also try to choose a primary care that has a good urgent care center to avoid the ER.

[redir]

Take a ride on your bike through your city and town and you will ride right by the Fire Department, the Police Department, your Public Works Department and your Hospital.

Which one is not like the others?

[93legendti]

there are 33M people in Canada. last year 42K of those went outside the country for help due to long waits = .12 percent. Wonder how many Americans go outside the country due to the prices here? I'd take the Canada numbers any day. 29M Americans still uninsured. No death panels so far with Bamacare.

"We estimate some 1,200,000 Americans will travel outside the US for medical care this year (2014)."

And many pay out of pocket for US care. Our Canadian friends did. Many also come here electively for cardio thoracic surgery and cancer treatments, etc. Canada is 30 minutes away when we lived there we saw it a lot.

The Cardiac surgeon at the biggest Hopital in Windsor only works 2 days a week, that's why our friend waited 5 days in the ER for an angiogram with a 90% blockage and then had to take a 90 minute ambulance ride to London, Ont. for surgery. He is lucky to be alive. That could never happen here.
Thank G-d for "free" medical care.

His wife waited 1 year for scoliosis surgery. She was all set to have it done here and at 100% cost to her when OHIP finally gave her a date for surgery. She was in tremendous pain. That could never happen here.
Thank G-d for free "medical" care.

[93legendti]

I think that simply capping physician salaries at 75,000 would be enough to solve the financial problems of our medical care system. No one in their right mind would undergo the educational rigors to be a physician, the stress of lives directly in your hands, work at all hours of the night, and ridiculous bureaucracy of the system to work for a salary that would not even cover rent in many areas of the country.

I'm sure you were joking.

If you are not, then we should just salary all Americans at 75,000, from McDonald's to the presidency. Ban all profits for all companies for good measure. I'll take the job at McDonald's. Much easier to sleep at night knowing that if I filled someone's order wrong it no big deal.

Jon

I was joking. I miss my $660/month premium that I paid before the healthcare law was passed and "saved" the system. $1130/month now. Deductibles are higher to boot.

[eddief]

the balance still seems way off in favor of single payer to me. Still Americans pay 2x the rest of the civilized world, with worse outcomes, and 29M uninsured. We can land on the moon, we can fix the healthcare system.

And many pay out of pocket for US care. Our Canadian friends did. Many also come here electively for cardio thoracic surgery and cancer treatments, etc. Canada is 30 minutes away when we lived there we saw it a lot.

The Cardiac surgeon at the biggest Hopital in Windsor only works 2 days a week, that's why our friend waited 5 days in the ER for an angiogram with a 90% blockage and then had to take a 90 minute ambulance ride to London, Ont. for surgery. He is lucky to be alive. That could never happen here.
Thank G-d for "free" medical care.

His wife waited 1 year for scoliosis surgery. She was all set to have it done here and at 100% cost to her when OHIP finally gave her a date for surgery. She was in tremendous pain. That could never happen here.
Thank G-d for free "medical" care.

[malcolm]

Yep, I'd agree that $5500 seems reasonable.

$19,000... probably not.

And yet, if you don't have health insurance (where the companies negotiate that outrageous billed rate down)... guess what you pay?

Didn't read the entire thread because as a physician I hate these threads. The public has little idea how medical billing works.
Billing is all based on a percentage of what medicare pays and you bill based on that. What you bill you know you'll never get but that is how the game works.

I've always been an ER doc so I didn't worry about it much until we became fee for service then that changed and I learned a lot about it quickly.

Now I'm a business owner, urgent care clinics and I have to know even more about it. Self pay makes things even more complicated to the point where I would almost not even see cash patients. You basically have to bill self pay patients the same as you would insured patients. If you bill less the insurance companies view this is fraud and will not privilege you. I suppose you could bill them more than you collect for insurance but I don't know anyone that does that outside some cash only boutique practices.
I can be hard to figure out what to bill and usually in our setting involves either an additional bill which you'll never collect or sending refunds which we commonly do.

The system sucks but physicians didn't create it and it really sucks if you don't have insurance.

[paredown]

And many pay out of pocket for US care. Our Canadian friends did. Many also come here electively for cardio thoracic surgery and cancer treatments, etc. Canada is 30 minutes away when we lived there we saw it a lot.

The Cardiac surgeon at the biggest Hopital in Windsor only works 2 days a week, that's why our friend waited 5 days in the ER for an angiogram with a 90% blockage and then had to take a 90 minute ambulance ride to London, Ont. for surgery. He is lucky to be alive. That could never happen here.
Thank G-d for "free" medical care.

His wife waited 1 year for scoliosis surgery. She was all set to have it done here and at 100% cost to her when OHIP finally gave her a date for surgery. She was in tremendous pain. That could never happen here.
Thank G-d for free "medical" care.

I could add a similar story when my father was first diagnosed with renal carcinoma (Vancouver). Effectively, he was told that he should go home and put his affairs in order since he'd had a good long life (he was 74 at the time). He had to wait over 6 months for a hospital appointment (Cat scan?--details are foggy) that confirmed the cancer. There were no options available to him for treatment.

So the queuing is a real problem in Canada (as in the UK)--and effectively in both countries you have a two tiered system. While we were in the UK, we were enrolled in National Health for basic care, but a perk of my wife's job was also additional private insurance that allowed you to bypass the queue. In both countries, people who can afford to will seek medical treatment elsewhere--and the US in particular acts as a kind of safety valve for the Canadian system.

Also, you have bureaucrats making decisions about the provision of service--like arbitrary cutoffs by age for who can get an amniocentesis for example.

The Canadians have thrown a huge amount of money at the problem of queuing in recent years as has the UK (which started while we were there under Tony Blair), but I don't think that there have been improvements on the ground. My Canadian friends often are unable to find a primary care doctor if they lose the one they have, care for my ailing and elderly mother has been a constant battle for my siblings just to find a primary care doctor etc.

This is why I am of two minds regarding what to do about care--but I do think some problems (like portability of medical records and an end to the inane and farcical tail chasing that happens with billing every time we get near a doctor's office or hospital) could be solved either by a single payer or forced coordination (like Visa/Mastercard for example).

(It is worth mentioning though that Canada is a public insurance/single payer that relies on a mix of public hospitals, and self-employed physicians and the gamut of professionals to staff the system--not a full public health care system like National Health in the UK.)

[stackie]

I was joking. I miss my $660/month premium that I paid before the healthcare law was passed and "saved" the system. $1130/month now. Deductibles are higher to boot.

Thank god. The nurses where I work in coastal California are making more than 75k!

I'd be happy to be salaried and I do think that it would solve some of the problems in medicine wrt greed affecting the decision process as to what treatment people need. However, it would also take away incentive to work efficiently or overtime. Try getting a case booked after hours at a VA hospital!

I am also fully in support of a single payor system that allows access to certain basic procedures to all Americans at little cost. Note, I didn't say zero cost because that incentivizes people to abuse. Why take time off work to see your primary doc when ER is always open and costs no more when you are on mediCal. For that matter, why pay a taxi to take you to ER for your stuffy nose. An ambulance is free if you are on mediCal. I'm not joking. This abuse happens, and not infrequently.

I am not in favor of all procedures for everyone. Appendicitis gets treated for everyone. Heart transplants for a select few that will benefit society the most. Unless you have the cash to pay. I know that is offensive to some, but medical care is not all that different from food. Everybody will need some. Some will require more fancy food. We can all eat at McDonald's. Not everyone can eat at the French Laundry. Our society just can't support that. To allow full unfettered access to every procedure in our armamentarium would near bankrupt our country. I can't imagine that anyone here is interested in doubling their tax burden so that society can gorge themselves on a bottomless trough of medical care. And, please don't say that physician salaries are the problem. Fact, if all doctors agreed to care for Medicare patients at zero cost, Medicare would still be overbudget. The problem is across the board. You are dealing with top level people at all levels, high technology devices, cutting edge drug research. None of this is free.

Just my two cents from someone fully in the trenches.

[batman1425]

Then lots of x-rays of body parts that had only been incidentally banged up--despite me telling them that they were not needed

This is a problem in most areas of medicine, but particularly EDs. Our society is so litigious that practicing defensive medicine has become the norm to protect the physician. Adding more total costs to the system, etc. CT Scans are a particularly hot topic in that area.

[batman1425]

I am also fully in support of a single payor system that allows access to certain basic procedures to all Americans at little cost. Note, I didn't say zero cost because that incentivizes people to abuse. Why take time off work to see your primary doc when ER is always open and costs no more when you are on mediCal. For that matter, why pay a taxi to take you to ER for your stuffy nose. An ambulance is free if you are on mediCal. I'm not joking. This abuse happens, and not infrequently.


^^^^^THIS.

The amount of money hospitals throw down the drain treating people in ERs that have no business being there in the first place is astounding. The people that do this are also the ones that crap and moan about being triaged for 7 hours because their stuffy nose isn't as urgent as the car accident, heart attack, etc. that keep filing in the door. When they finally do get seen, they have to get the full work up - gotta make sure the bases are covered right - dont' want to get sued... Then they file reports about their lack of satisfaction later on and the hospital risks not getting compensated for the care from insurance that is tied to patient satisfaction scores. Its a lose-lose.

[malcolm]

^^^^^THIS.

The amount of money hospitals throw down the drain treating people in ERs that have no business being there in the first place is astounding. The people that do this are also the ones that crap and moan about being triaged for 7 hours because their stuffy nose isn't as urgent as the car accident, heart attack, etc. that keep filing in the door. When they finally do get seen, they have to get the full work up - gotta make sure the bases are covered right - dont' want to get sued... Then they file reports about their lack of satisfaction later on and the hospital risks not getting compensated for the care from insurance that is tied to patient satisfaction scores. Its a lose-lose.

You sound like an ER doc, like me. It used to amaze me that ERs would advertise these low wait times and all the marketing ploys to get people to come to the ER then bitch about it when they did.

Many people misuse the ER and certainly some people with insurance that should know better, but at least when I was there a significant proportion of folks that didn't have true emergencies were there because they had no where else to go.

The current health care reform won't help the situation for most of them. It makes no sense to give someone that can't afford health care a plan with a deductible they also can't afford.

[batman1425]

Totally agree Malcom. A key to providing better care in the ED is improving access to PCP care or a high quality network of urgent care facilities with fewer monetary barriers for use. Lessens the burden on the department - operating costs go down, quality of care goes up because the staff can focus on the sicker people. Quality urgent care facilities don't exist in a lot of places, and as you said, the high premium/deductible plans don't make it any easier for the folks to seek care at a PCP vs. the department.

[eddief]

only 29M without insurance still eligible to go to the emergency room when they need medical attention. That's some progress, I guess.

Totally agree Malcom. A key to providing better care in the ED is improving access to PCP care or a high quality network of urgent care facilities with fewer monetary barriers for use. Lessens the burden on the department - operating costs go down, quality of care goes up because the staff can focus on the sicker people. Quality urgent care facilities don't exist in a lot of places, and as you said, the high premium/deductible plans don't make it any easier for the folks to seek care at a PCP vs. the department.

[buddybikes]

Places like CVS and similar setting up small ad hoc walk in but no doctor. Then full ER. Good urgent care at hospital (in case xrays or real work needed) is only available in select areas/providers. THen they aren't open when you need them, week ends. Like people get sick only 9-5 weekdays.

Why can't there be urgen care canter/ER were they quickly triage and send you left or right and then time/care/charges are handled appropriately.

Hospital I go to has an Urgent Care speicalist, he doesn't want to be a primary care guy, but he has 20 years experience. Fantastic service, he has diagnosed more conditions of me than my primary care. This type of physicians and NP's should be greatly enhanced.