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Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 08:55AM
When hospitals have less margins, as Obamacare will cause:
[archinte.jamanetwork.com]
[capsules.kaiserhealthnews.org]

It will begin a slow (and long) trickle of hospitals closing. In NY, it took about 30 years. Initially, the hospitals will reduce amenities and not reinvest into the look and feel of the institution (because they have no money). Then it will reduce services (social workers, aides, etc). When hospitals close entire departments (i.e. Obstetrics), it is already severe. When they stop buying insurance because they need to hire nurses, it is a heartbeat from closure. When enough hospitals close, it becomes a crisis because all of those medicaid patients will then flood into surrounding hospitals and cause their slow demise as well.

The real kicker is that medicaid patients are much more likely to sue than patients with private insurance. Here's an example of what malpractice is doing to hospitals:
[www.nytimes.com]

And lets not forget one of the main causes for St. Vincent's Hospital in NYC to close: malpractice costs. How are we supposed to take care of our own, when we keep suing these institutions into closure?


Just my 2 cents worth (I know many here wont value what I've got to say at even that much)...



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: Avenger
Date: July 17, 2012 09:01AM
What do you know? You are just a doctor. I will have to wait to hear from the rest of the gang here.
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Re: Hospital Crisis and Obamacare
Posted by: Pam
Date: July 17, 2012 09:08AM
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 09:09AM
Here is another 'rosy' view of Obamacare:

[www.nytimes.com]



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 09:13AM
Quote
Pam
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.

True, but at least it wont bring down the rest of America. The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc). That's because the democrats love trial lawyers and frivolous lawsuits. By creating an extension of medicaid, it will expand the trial lawyers' influence on the rest of America. This is going to get very, very ugly. I'm glad that I'm in mid-career...and wont have to feel the repercussions too much. I'm really concerned about our kids and the next generation.



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: Avenger
Date: July 17, 2012 09:13AM
You tell the doctor's office you have Medicaid and they practically hang up on you.
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Re: Hospital Crisis and Obamacare
Posted by: Acer
Date: July 17, 2012 09:16AM
"Yet Medicaid has never been especially popular."

I wonder why...oh, here's the answer! "Medicaid beneficiaries have limited means, and their low incomes usually translate into below-average political influence."


Nobody who's got money is a fan of Medicaid until Mother runs out of money but still needs another 3 years of nursing home care.
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Re: Hospital Crisis and Obamacare
Posted by: Avenger
Date: July 17, 2012 09:20AM
Quote
Acer

I wonder why...oh, here's the answer! "Medicaid beneficiaries have limited means, and their low incomes usually translate into below-average political influence."

No, it is because it is a lousy insurance.
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Re: Hospital Crisis and Obamacare
Posted by: swampy
Date: July 17, 2012 09:23AM
When 83% of current doctors say they have considered getting out of medicine due to Obama care, there won't be enough doctors to staff hospitals since there are not enouh doctors in the pipeline to make up the loss.

I see only those able to pay cash getting medical care in 20-30 years. Look at Canada. The shortage of doctors has lead to long wait times to get seen. The rich come to the USA pay cash and get care.



If you don't stand for something, you'll probably fall for anything.t



Edited 1 time(s). Last edit at 07/17/2012 09:25AM by swampy.
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Re: Hospital Crisis and Obamacare
Posted by: Acer
Date: July 17, 2012 09:23AM
Quote

No, it is because it is a lousy insurance.

Because it low-balls its payments. How can we fix that?



Edited 1 time(s). Last edit at 07/17/2012 09:23AM by Acer.
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Re: Hospital Crisis and Obamacare
Posted by: lafinfil
Date: July 17, 2012 09:24AM
No offense to you personally, because I am sure that you are a good doctor. As I see it one major problem with the malpractice "crisis" is the refusal over the years for the medical profession to police itself and rid itself of the bad actors instead of looking the other way (primarily state medical licensing) Get rid of the revolving door of drug addicted anesthesiologist, the sloppy surgeons, etc... would be a start. Letting them walk away to go practice in a different state may solve a local problem but not a systemic one. In all your years have you ever questioned the actions of a peer? If so did you speak up ?

I was an observer from within for 15 years and an observer / advocate from the patient side for more than that (still am) If my mother or uncle is in need of care, I work my list of old contacts and ask for "non-recommendations". Who should we avoid, and then who should we see. Docs I know were complaining about the same (malpractice) over 30 years ago so this is nothing new IMHO - just a new convenient target. It's one of those "heal thy self" things but the overseers of the profession don't seem willing.



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Re: Hospital Crisis and Obamacare
Posted by: Acer
Date: July 17, 2012 09:26AM
Every other supplier in the world expands when the demand increases, but in American health care we keep hearing threats that supply will shrink. How can we fix that?



Edited 1 time(s). Last edit at 07/17/2012 09:28AM by Acer.
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Re: Hospital Crisis and Obamacare
Posted by: swampy
Date: July 17, 2012 09:30AM
I have to agree somewhat with lafinfil. When my long time family doctor died I lost my medical gate keeper. I relied on him to direct me to the best doctors and who to avoid.



If you don't stand for something, you'll probably fall for anything.t
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Re: Hospital Crisis and Obamacare
Posted by: Pam
Date: July 17, 2012 09:44AM
Quote
wowzer
Quote
Pam
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.

True, but at least it wont bring down the rest of America. The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc). That's because the democrats love trial lawyers and frivolous lawsuits. By creating an extension of medicaid, it will expand the trial lawyers' influence on the rest of America. This is going to get very, very ugly. I'm glad that I'm in mid-career...and wont have to feel the repercussions too much. I'm really concerned about our kids and the next generation.

Well no, it's happened in Virginia as well.

I don't and never have seen Obamacare as a rigid document. In my dream world, after the election, both sides can put their partisanship aside and iron out some kinks. It's fine if it's in back rooms and they snipe in front of the cameras. As long as it's done.
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Re: Hospital Crisis and Obamacare
Posted by: Pam
Date: July 17, 2012 09:46AM
Quote
swampy
When 83% of current doctors say they have considered getting out of medicine due to Obama care, there won't be enough doctors to staff hospitals since there are not enouh doctors in the pipeline to make up the loss.

I see only those able to pay cash getting medical care in 20-30 years. Look at Canada. The shortage of doctors has lead to long wait times to get seen. The rich come to the USA pay cash and get care.

False [www.politifact.com]
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Re: Hospital Crisis and Obamacare
Posted by: mrbigstuff
Date: July 17, 2012 09:58AM
That's because the democrats love trial lawyers and frivolous lawsuits.

I was willing to listen up to this point in the conversation. Frivolous lawsuits are not anyone's domain. Although the poor typically have more to gain from lawsuits, and our system is rather broken in this regard, it's hard to ascribe political partisanship to their goals. In fact, it's downright nonsense.
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Re: Hospital Crisis and Obamacare
Posted by: michaelb
Date: July 17, 2012 10:00AM
This thread makes no sense to me, what issue are we discussing?

The ACA has quality incentive payments built into to Medicare reimbursement? How is that a bad idea generally?

The ACA will dramatically reduce the number of uninsured going to hospitals for acute care. This is a major problem for hospitals everywhere. Having coverage for most everyone wil outweigh reimbursement rate issues (which actually aren't going down) by 10 to 1. The States that opt out of the Medicaid expansion are of course going to have major problems that they will be completely responsible for bringing on themselves. Their money will flow for once to the states that do expand so that will be a nice change of pace. The overwhelming pressure and obvious need will flip those states, it is just a matter of time (but yes, some of their hospitals may collapse due to the uninsured).

Malpractice lawsuits are not a major factor in overall health care spending. But States are free to adopt all the changes and restrictions they want. Malpractice is not a federal issue, that is left to the states. The States that have adopted malpractice reform haven't seen any meaningful cost reductions. But reasonable reform makes sense to me too.
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Re: Hospital Crisis and Obamacare
Posted by: swampy
Date: July 17, 2012 10:11AM
Pam, Politifact it all you want, but I think the number does reflect a majority of doctor's feelings about Obamatax.

I have seen a great many doctors and medical practicioners over the past three years and have discussed current trends in health care. _None_ that I talked with liked the future they saw coming. Not a one! Most agreed that costs would rise, care would be rationed in some degree and overall patient care will decline due to lack of doctors. Tort reform was a major concern for them financially.

Their other big concern was the USPSTF. It was my oncologist who pointed out that the the U.S. Preventive Services Task Force, that recommended mammograms for women under 50 were not beneficial, did not have a single clinical oncologist or breast surgeon on the panel. Her fear is that this panel will be the determiner of patient care and health decisions will be bast on cost effectiveness.



If you don't stand for something, you'll probably fall for anything.t
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 10:24AM
Quote
Acer
"Yet Medicaid has never been especially popular."

I wonder why...oh, here's the answer! "Medicaid beneficiaries have limited means, and their low incomes usually translate into below-average political influence."


Nobody who's got money is a fan of Medicaid until Mother runs out of money but still needs another 3 years of nursing home care.



While what you say is partially true, there is far worse. Medicaid patients will sue doctors more often and for more frivolous reasons. Thus, as a doctor, you lose money on attending a medicaid patient AND you get sue by them more often. Why would any physician want to accept medicaid patients?



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: davester
Date: July 17, 2012 10:26AM
Quote
swampy
Most agreed that costs would rise, care would be rationed in some degree and overall patient care will decline due to lack of doctors.

In other words, they expect exactly the same thing to occur that has been happening prior to the ACA. Don't they think there'll be any changes at all?



"In science it often happens that scientists say, 'You know that's a really good argument; my position is mistaken,' and then they would actually change their minds and you never hear that old view from them again. They really do it. It doesn't happen as often as it should, because scientists are human and change is sometimes painful. But it happens every day. I cannot recall the last time something like that happened in politics or religion." (1987) -- Carl Sagan
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Re: Hospital Crisis and Obamacare
Posted by: Pam
Date: July 17, 2012 10:42AM
Quote
swampy
Pam, Politifact it all you want, but I think the number does reflect a majority of doctor's feelings about Obamatax.

I have seen a great many doctors and medical practicioners over the past three years and have discussed current trends in health care. _None_ that I talked with liked the future they saw coming. Not a one! Most agreed that costs would rise, care would be rationed in some degree and overall patient care will decline due to lack of doctors. Tort reform was a major concern for them financially.

Their other big concern was the USPSTF. It was my oncologist who pointed out that the the U.S. Preventive Services Task Force, that recommended mammograms for women under 50 were not beneficial, did not have a single clinical oncologist or breast surgeon on the panel. Her fear is that this panel will be the determiner of patient care and health decisions will be bast on cost effectiveness.

Costs are already going up and have been for a long time. Care has been rationed much longer via financial limitations of patients and health insurance companies denying or restricting treatment overriding doctor decisions. Tort reform is one of those portions of Obamacare that could be addressed if both parties sit down to do their jobs and stop pandering to bases or who lines their pockets.

I applaud the USPSTF's recommendations on mammograms. They had the balls to fight the groups that are pushing for more. Not because it helps women, but because it makes money! Talk to radiologists! The money made on these machines, on the unnecessary biopsies that result, on the groups fundraising for breast cancer, and you should be sick. Women have been sold a huge ball of crap and gratefully shell out the money, and pooh pooh the stress because they were told it was benign. The numbers are huge. The amount of money is even larger. People always revert to, well if it saves a life, but that's not the case. Which is why the guidelines were changed. You find a lump, you get checked out. You have family history, you start earlier. Otherwise you follow the guidelines. I truly, sorely wish all of that well intentioned, donated money went to research to determine the cause of breast cancer and identify which cancers are worrisome and which are not. Not spend the money lining pockets and putting women through the wringer.

1.6 million biopsies are done each year. 90% are benign. That means 1.44 million women were subjected to cost, pain, and stress. That number should be far, far lower. It should invoke outrage just as similar numbers did for prostate cancer. But that cancer involves men and is not a sexy money maker. They tried.
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Re: Hospital Crisis and Obamacare
Posted by: mattkime
Date: July 17, 2012 10:45AM
wowzer, how do you really feel?



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Re: Hospital Crisis and Obamacare
Posted by: rgG
Date: July 17, 2012 11:01AM
Quote
Pam

Costs are already going up and have been for a long time. Care has been rationed much longer via financial limitations of patients and health insurance companies denying or restricting treatment overriding doctor decisions. Tort reform is one of those portions of Obamacare that could be addressed if both parties sit down to do their jobs and stop pandering to bases or who lines their pockets.

I applaud the USPSTF's recommendations on mammograms. They had the balls to fight the groups that are pushing for more. Not because it helps women, but because it makes money! Talk to radiologists! The money made on these machines, on the unnecessary biopsies that result, on the groups fundraising for breast cancer, and you should be sick. Women have been sold a huge ball of crap and gratefully shell out the money, and pooh pooh the stress because they were told it was benign. The numbers are huge. The amount of money is even larger. People always revert to, well if it saves a life, but that's not the case. Which is why the guidelines were changed. You find a lump, you get checked out. You have family history, you start earlier. Otherwise you follow the guidelines. I truly, sorely wish all of that well intentioned, donated money went to research to determine the cause of breast cancer and identify which cancers are worrisome and which are not. Not spend the money lining pockets and putting women through the wringer.

1.6 million biopsies are done each year. 90% are benign. That means 1.44 million women were subjected to cost, pain, and stress. That number should be far, far lower. It should invoke outrage just as similar numbers did for prostate cancer. But that cancer involves men and is not a sexy money maker. They tried.

I agree. Could not agree more.

Also, we have to realize that good medicine is not treating every illness with the latest and most expensive high tech machines and drugs when often an older, more proven, and cheaper alternative exists. But the drug companies sell doctors on the latest and the greatest, and many doctors don't even consider the cost, they just figure that insurance will cover it, like it is a free lunch. And the drug makers advertise all the latest drugs directly to the consumer and tell you to ask your doctor about prescribing them for you.

There is way too much overhead in medicine. You should not have to have a staff of people just to code bills, how insane. It is this overhead, coupled with high malpractice insurance, the subsequent overuse of expensive testing and procedures to cover the doctor's liability, that have driven up the cost of health care.

The current health care bill needs work, a lot of work, but to just leave things as they are is not an answer. As has been said, the politicians, doctors, insurance companies, drug companies, and the states need to work this out. It can be fixed, but everyone is going to have to give a little.





Roswell, GA (Atlanta suburb)
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 11:15AM
Quote
lafinfil
No offense to you personally, because I am sure that you are a good doctor. As I see it one major problem with the malpractice "crisis" is the refusal over the years for the medical profession to police itself and rid itself of the bad actors instead of looking the other way (primarily state medical licensing) Get rid of the revolving door of drug addicted anesthesiologist, the sloppy surgeons, etc... would be a start. Letting them walk away to go practice in a different state may solve a local problem but not a systemic one. In all your years have you ever questioned the actions of a peer? If so did you speak up ?

I was an observer from within for 15 years and an observer / advocate from the patient side for more than that (still am) If my mother or uncle is in need of care, I work my list of old contacts and ask for "non-recommendations". Who should we avoid, and then who should we see. Docs I know were complaining about the same (malpractice) over 30 years ago so this is nothing new IMHO - just a new convenient target. It's one of those "heal thy self" things but the overseers of the profession don't seem willing.

First off, the so called, 'bad' doctors (i.e. those with many malpractice losses) are frequently taking care of high risk patients. It is ONLY the plaintiff attorneys who label these doctors as, 'bad'. I sit on my hospital's peer review board--and yes, mistakes happen--but there are almost always extenuating circumstances. Very rarely do I find a doctor who has done something truly egregious, but to answer your question, yes, I've fired those extremely rare 'bad' physicians (only 1 or 2 over a 15 year experience in administration). It's far trickier than you imagine, as there are always grievance meetings and due rights from human resources. Also, hospitals are not allowed to arbitrarily deny privileges to doctors--unless there are specific and substantiated reasons, if a physician presents the appropriate credentials and meets the standards, the hospital is obligated to grant privileges. (BTW- these rules and regulations were created by other lawyers who make the cost of doing business more expensive.)


To address the issue of legitimacy of malpractice suits, if I recall correctly (I'll try to find the reference), Harvard law school's study many years ago demonstrated that only one third of all malpractice settlements and judgements were in fact as a result of malpractice. Furthermore, of the cases of legitimate malpractice, only 40% of the patients actually ever sued. The data was based upon closed cases and peer reviewed data, and the Harvard Law team had the Harvard Medical team review the medical cases. When that study was released, it quickly became apparent to me that lawsuits mean nothing about the quality of the physician. Nothing.


What the Harvard study meant to me was that lawyers are far worse at screening out 'bad' lawsuits. If there is a profession which needs to be brought under control, it is law and judisprudence. I think that the entire law profession should be required to do a top down review of their practices and policies to ensure that only legitimate cases are brought to trial.



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 11:18AM
Quote
Pam
Quote
wowzer
Quote
Pam
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.

True, but at least it wont bring down the rest of America. The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc). That's because the democrats love trial lawyers and frivolous lawsuits. By creating an extension of medicaid, it will expand the trial lawyers' influence on the rest of America. This is going to get very, very ugly. I'm glad that I'm in mid-career...and wont have to feel the repercussions too much. I'm really concerned about our kids and the next generation.

Well no, it's happened in Virginia as well.

I don't and never have seen Obamacare as a rigid document. In my dream world, after the election, both sides can put their partisanship aside and iron out some kinks. It's fine if it's in back rooms and they snipe in front of the cameras. As long as it's done.


I would vote for that! But you and I both know that the world has become very unforgiving and very unwilling to bend. The truth is that obamacare was forced down the throats of the republicans. You can bet that they will fight it. I bet some democratic governors will not enact the medicaid expansion, as long term projections show billions of losses to the state when the federal government pulls out financial support. Simply put, the math just doesn't work out.



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: Lemon Drop
Date: July 17, 2012 11:19AM
I appreciate the beautiful, state of the art, constantly renovated hospitals in my state. I notice those other places when I travel around the country. It couldn't be that we have too many high price hospital beds in some areas and can't fill them, could it? Just asking.

Quote

The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc).

It's hard to take easily disproved partisan comments like that seriously. Continuing to treat this like a political problem instead of a serious national challenge isn't going to get us anywhere.

Here are the 10 states with the safest hospitals, meaning you are least likely to get killed in one of them, according to a recent national survey:
Mass, Maine, Vermont, Illinois, Tenn, VA, MI, CA, DE, MN.
What are those states doing right?
We know one has "Romneycare." rolleyes smiley
Let's look at the best and learn and copy that and continue to innovate, reform, and improve.
Time to quit the partisan whining in this issue.
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Re: Hospital Crisis and Obamacare
Posted by: Pops
Date: July 17, 2012 11:23AM
Quote
wowzer

First off, the so called, 'bad' doctors (i.e. those with many malpractice losses) are frequently taking care of high risk patients. It is ONLY the plaintiff attorneys who label these doctors as, 'bad'.
From a layman's perspective, I have always believed this to be the case.
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 11:26AM
Quote
michaelb
This thread makes no sense to me, what issue are we discussing?

The ACA has quality incentive payments built into to Medicare reimbursement? How is that a bad idea generally?

The ACA will dramatically reduce the number of uninsured going to hospitals for acute care. This is a major problem for hospitals everywhere. Having coverage for most everyone wil outweigh reimbursement rate issues (which actually aren't going down) by 10 to 1. The States that opt out of the Medicaid expansion are of course going to have major problems that they will be completely responsible for bringing on themselves. Their money will flow for once to the states that do expand so that will be a nice change of pace. The overwhelming pressure and obvious need will flip those states, it is just a matter of time (but yes, some of their hospitals may collapse due to the uninsured).

Malpractice lawsuits are not a major factor in overall health care spending. But States are free to adopt all the changes and restrictions they want. Malpractice is not a federal issue, that is left to the states. The States that have adopted malpractice reform haven't seen any meaningful cost reductions. But reasonable reform makes sense to me too.

I can't spend the time to fight point to point (I have data and evidence for each of them). Suffice to say that the 'quality' metrics have been reviewed by the doctors and overall we think that they wont help at all (search medscape 2012 survey).

States that opt out wont face the financial burdens under ACA. The Federal government would (i.e. taxpayers). This is the major concern--how in the world is ACA going to control costs when it has eluded generations of administrators and politicians? The simple answer is that costs will balloon and the individual taxpayer will get saddled with the bill.

As for malpractice--how can it be a state's issue? If insurers are multi-state (and many if not all attorney groups are inter-state), then it is definitely interstate commerce. In addition, since ACA has setup national benchmarks of quality and safety metrics for hospitals and doctors, thereby establishing a national standard of care, then all hospital based lawsuits should be Federal. I suspect some hospital/group/organization will try that argument very shortly.



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 11:29AM
Quote
mattkime
wowzer, how do you really feel?

Just felt a little more concerned about the US of A and I had to vent (which I very rarely do as it is completely counter-productive)...



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: Pam
Date: July 17, 2012 11:31AM
Quote
wowzer
Quote
Pam
Quote
wowzer
Quote
Pam
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.

True, but at least it wont bring down the rest of America. The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc). That's because the democrats love trial lawyers and frivolous lawsuits. By creating an extension of medicaid, it will expand the trial lawyers' influence on the rest of America. This is going to get very, very ugly. I'm glad that I'm in mid-career...and wont have to feel the repercussions too much. I'm really concerned about our kids and the next generation.

Well no, it's happened in Virginia as well.

I don't and never have seen Obamacare as a rigid document. In my dream world, after the election, both sides can put their partisanship aside and iron out some kinks. It's fine if it's in back rooms and they snipe in front of the cameras. As long as it's done.


I would vote for that! But you and I both know that the world has become very unforgiving and very unwilling to bend. The truth is that obamacare was forced down the throats of the republicans. You can bet that they will fight it. I bet some democratic governors will not enact the medicaid expansion, as long term projections show billions of losses to the state when the federal government pulls out financial support. Simply put, the math just doesn't work out.

Thing is Obamacare is for the most part, a Republican plan. They couldn't pass it and let Obama get a win. They had to act as though this plan was a product of liberal Democratic minds. As it is Obama had to make deals with pharma he didn't want to get it passed. As without them it would not have passed. So you have Republicans who want it gone simply to take away a Democratic victory, and you have pharma and as well as the insurance companies lining pockets to protect their profits. Just who is really looking out for the average American citizen?

Long term projections are guides. That's it. If congress cannot get their collective asses together and work on what's best for the country it won't matter if Obamacare stays in place.
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 11:34AM
Quote
Pam
Thing is Obamacare is for the most part, a Republican plan. They couldn't pass it and let Obama get a win. They had to act as though this plan was a product of liberal Democratic minds. As it is Obama had to make deals with pharma he didn't want to get it passed. As without them it would not have passed. So you have Republicans who want it gone simply to take away a Democratic victory, and you have pharma and as well as the insurance companies lining pockets to protect their profits. Just who is really looking out for the average American citizen?

Long term projections are guides. That's it. If congress cannot get their collective asses together and work on what's best for the country it won't matter if Obamacare stays in place.


It could be...if the republicans passed this, I'd be very upset too. I could care less which party passed it--the republicans are trying to fight it because it is politically convenient. I'm concerned about the long term consequences--which are enormous.



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: August West
Date: July 17, 2012 11:36AM
Quote

search medscape 2012 survey

Are you referring to Medscape's 2012 Physician's Compensation Survey?
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Re: Hospital Crisis and Obamacare
Posted by: Pam
Date: July 17, 2012 11:45AM
Quote
wowzer
Quote
Pam
Thing is Obamacare is for the most part, a Republican plan. They couldn't pass it and let Obama get a win. They had to act as though this plan was a product of liberal Democratic minds. As it is Obama had to make deals with pharma he didn't want to get it passed. As without them it would not have passed. So you have Republicans who want it gone simply to take away a Democratic victory, and you have pharma and as well as the insurance companies lining pockets to protect their profits. Just who is really looking out for the average American citizen?

Long term projections are guides. That's it. If congress cannot get their collective asses together and work on what's best for the country it won't matter if Obamacare stays in place.


It could be...if the republicans passed this, I'd be very upset too. I could care less which party passed it--the republicans are trying to fight it because it is politically convenient. I'm concerned about the long term consequences--which are enormous.

I think it's a start. This country finally has a healthcare plan. No matter who presented the bill it was going to be constructed and viewed with partisan priorities. And with various hands in various pockets. Now if the adults would please get in the room and start looking at this from the standpoint of the American people.
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Re: Hospital Crisis and Obamacare
Posted by: Lemon Drop
Date: July 17, 2012 11:51AM
Quote

Now if the adults would please get in the room and start looking at this from the standpoint of the American people.


That would be refreshing!
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Re: Hospital Crisis and Obamacare
Posted by: Avenger
Date: July 17, 2012 12:00PM
Quote
Pam


1.6 million biopsies are done each year. 90% are benign.

How did they KNOW it is benign? That's right, they did a biopsy! Here is another example you could use. 90% of people who bought collision coverage never had an accident. Why did they bought coverage one wonders?
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Re: Hospital Crisis and Obamacare
Posted by: Lemon Drop
Date: July 17, 2012 12:26PM
This thread needs davester or Ted king. I think it was one or maybe both of those guys who provided research in a much earlier thread showing that the claims that malpractice claims are a major cause of problems and expense in the health care system are bunk. It's a partisan talking point that caught fire and continues to be exploited by groups who want to limit physician and hospital accountability and liability for mistakes.
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Re: Hospital Crisis and Obamacare
Posted by: Avenger
Date: July 17, 2012 12:42PM
We have a doctor in the house and you are looking for davester? Ask him about solar panels and water heaters.
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Re: Hospital Crisis and Obamacare
Posted by: Pam
Date: July 17, 2012 12:49PM
Quote
Avenger
Quote
Pam


1.6 million biopsies are done each year. 90% are benign.

How did they KNOW it is benign? That's right, they did a biopsy! Here is another example you could use. 90% of people who bought collision coverage never had an accident. Why did they bought coverage one wonders?

Radiologists label findings as highly suspicious, suspicious, most likely benign, benign, and no findings. Obviously the only way to be 100% is to do a surgical biopsy. That is expensive, deforms, and has it's own risks. A surgeon could also miss the cancer! Needle biopsy, which is not as simple as you may think, may or may not hit the appropriate area or return definitive results so it's not 100%. Unless there are suspicious radiological findings or a family history with lesser findings all that is needed is close follow up. If that. Unfortunately anything other than no findings start a process of needle biopsies which can lead to unnecessary surgical biopsies (same patients), and in some cases mastectomies that were not viewed as preventative.

This is why money should be spent on understanding the cause(s) and different types of cancer. Some will never kill the woman (just like prostrate), some will be very aggressive. In situ is being treated as if it were invasive or guaranteed to be invasive.

Anyone who thinks 90% is acceptable, that time, money, and stress for 1.4 million American women each year is acceptable really doesn't give a flip about women.
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Re: Hospital Crisis and Obamacare
Posted by: mrbigstuff
Date: July 17, 2012 01:09PM
Quote
wowzer

First off, the so called, 'bad' doctors (i.e. those with many malpractice losses) are frequently taking care of high risk patients. It is ONLY the plaintiff attorneys who label these doctors as, 'bad'. I sit on my hospital's peer review board--and yes, mistakes happen--but there are almost always extenuating circumstances. Very rarely do I find a doctor who has done something truly egregious, but to answer your question, yes, I've fired those extremely rare 'bad' physicians (only 1 or 2 over a 15 year experience in administration). It's far trickier than you imagine, as there are always grievance meetings and due rights from human resources. Also, hospitals are not allowed to arbitrarily deny privileges to doctors--unless there are specific and substantiated reasons, if a physician presents the appropriate credentials and meets the standards, the hospital is obligated to grant privileges. (BTW- these rules and regulations were created by other lawyers who make the cost of doing business more expensive.)


To address the issue of legitimacy of malpractice suits, if I recall correctly (I'll try to find the reference), Harvard law school's study many years ago demonstrated that only one third of all malpractice settlements and judgements were in fact as a result of malpractice. Furthermore, of the cases of legitimate malpractice, only 40% of the patients actually ever sued. The data was based upon closed cases and peer reviewed data, and the Harvard Law team had the Harvard Medical team review the medical cases. When that study was released, it quickly became apparent to me that lawsuits mean nothing about the quality of the physician. Nothing.


What the Harvard study meant to me was that lawyers are far worse at screening out 'bad' lawsuits. If there is a profession which needs to be brought under control, it is law and judisprudence. I think that the entire law profession should be required to do a top down review of their practices and policies to ensure that only legitimate cases are brought to trial.

well, a sincere thank you if you have helped to bring about change at a fundamental level at your hospital. reform may be needed in all professions but medical care is certainly one of the professions where a patient is sometimes at the complete mercy of the medical establishment with little if any opportunity for reevaluation or second opinion.

the field of law should not be confused with the ambulance chasing attorneys. oversight by a third party is necessary but that function is currently being fulfilled by "independent contractors," i.e., the lowly slime of the law profession. the oversight has to come from.... wait for it... the government!



Edited 1 time(s). Last edit at 07/17/2012 01:10PM by mrbigstuff.
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Re: Hospital Crisis and Obamacare
Posted by: Lemon Drop
Date: July 17, 2012 01:10PM
Quote
Avenger
We have a doctor in the house and you are looking for davester? Ask him about solar panels and water heaters.

The doctor's premise is based on a debunked political talking point.
So yeah, something more objective would be appreciated.
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Re: Hospital Crisis and Obamacare
Posted by: $tevie
Date: July 17, 2012 01:45PM
Quote
Lemon Drop
This thread needs davester or Ted king. I think it was one or maybe both of those guys who provided research in a much earlier thread showing that the claims that malpractice claims are a major cause of problems and expense in the health care system are bunk. It's a partisan talking point that caught fire and continues to be exploited by groups who want to limit physician and hospital accountability and liability for mistakes.

Malpractice lawsuits take money from the rich and give to the poor: they are a concealed form of WEALTH DISTRIBUTION! OMG OMG



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Re: Hospital Crisis and Obamacare
Posted by: Carnos Jax
Date: July 17, 2012 01:47PM
Quote
wowzer
Quote
Pam
Hate to tell you, but it's already happened. Tossing Obamacare won't change the path we're already on.

True, but at least it wont bring down the rest of America. The only places where this was happening was the heavily democratic states (NY, MA, RI, CT, etc). That's because the democrats love trial lawyers and frivolous lawsuits. By creating an extension of medicaid, it will expand the trial lawyers' influence on the rest of America. This is going to get very, very ugly. I'm glad that I'm in mid-career...and wont have to feel the repercussions too much. I'm really concerned about our kids and the next generation.

You might've had a good start to your argument, until you said this.

Most of my friends and relatives are doctors (one of the side effects of being of Indian ethnicity) and most of the rest are in the medical field. Most of them are in favor of or at least giving the whole Obamacare thing the benefit of the doubt in terms of what it will do to the future of the industry. The only doctors I know of that are against it are happen to also earn a million plus a year (strange). One thing for sure, I've observed first hand a perceived (and most likely accurate) decline in the state of medical service provided in this country....Obamacare isn't even in effect.
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Re: Hospital Crisis and Obamacare
Posted by: Carnos Jax
Date: July 17, 2012 01:49PM
Quote
swampy
When 83% of current doctors say they have considered getting out of medicine due to Obama care, there won't be enough doctors to staff hospitals since there are not enouh doctors in the pipeline to make up the loss.

I see only those able to pay cash getting medical care in 20-30 years. Look at Canada. The shortage of doctors has lead to long wait times to get seen. The rich come to the USA pay cash and get care.

Swampy, I had the impression that medical schools in this country were at capacity, and that those who want to become a doctor had to go to overseas schools with cross accreditation.
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Re: Hospital Crisis and Obamacare
Posted by: Carnos Jax
Date: July 17, 2012 01:50PM
Quote
swampy
Pam, Politifact it all you want, but I think the number does reflect a majority of doctor's feelings about Obamatax.

I have seen a great many doctors and medical practicioners over the past three years and have discussed current trends in health care. _None_ that I talked with liked the future they saw coming. Not a one! Most agreed that costs would rise, care would be rationed in some degree and overall patient care will decline due to lack of doctors. Tort reform was a major concern for them financially.

Their other big concern was the USPSTF. It was my oncologist who pointed out that the the U.S. Preventive Services Task Force, that recommended mammograms for women under 50 were not beneficial, did not have a single clinical oncologist or breast surgeon on the panel. Her fear is that this panel will be the determiner of patient care and health decisions will be bast on cost effectiveness.

Look at my post. Perhaps it's just as anecdotal as yours, but by far different in it's conclusions.
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Re: Hospital Crisis and Obamacare
Posted by: Avenger
Date: July 17, 2012 01:50PM
Quote
Pam


Anyone who thinks 90% is acceptable, that time, money, and stress for 1.4 million American women each year is acceptable really doesn't give a flip about women.

So you would refuse the procedure for yourself based on statistics?
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Re: Hospital Crisis and Obamacare
Posted by: Avenger
Date: July 17, 2012 01:53PM
Quote
Lemon Drop

So yeah, something more objective would be appreciated.

Well, you are not going to get it from someone who dreams free national healthcare back in the UK but has for unknown reasons chosen his permanent domicile in the US.
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Re: Hospital Crisis and Obamacare
Posted by: Carnos Jax
Date: July 17, 2012 02:21PM
The irony is that you look to political bodies for your opinion on climate change, thereby throwing out the expert opinions of scientists who studied the issue. Yet when a doctor reflects your political position on healthcare, all of a sudden you have no problem with an 'expert' opinion. LOL, you're such a tool of the system.
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Re: Hospital Crisis and Obamacare
Posted by: wowzer
Date: July 17, 2012 02:36PM
Quote
Lemon Drop
This thread needs davester or Ted king. I think it was one or maybe both of those guys who provided research in a much earlier thread showing that the claims that malpractice claims are a major cause of problems and expense in the health care system are bunk. It's a partisan talking point that caught fire and continues to be exploited by groups who want to limit physician and hospital accountability and liability for mistakes.



I can tell you as a physician, CYA (defined below) is being done routinely. The trouble is that when you do not order the test, the trial attorneys point to your lack of testing as a source of malpractice. Even when there's no clear evidence that the test would do anything, that is a point which comes up. No jury in a low income county would find such a physician action as acceptable. As was stated recently, standards of medical practice is now defined by the juries and not by doctors. The intricacies of clinical decision making are fraught with uncertainty. It astounds me that we have a legal system which expects a jury of 'peers' to decide upon medical wrongdoing when groups of highly educated physicians cannot reach consensus in many such cases. No wonder why Harvard Law school found what they did--the tort system for healthcare does not make sense.


CYA Defined:
I will turn the question around, if you were a physician, and you had a patient who you were 95% sure of not having a devastating disease. Would you order a test to determine if the patient has the disease? Would you order the test if you were 10% certain that the patient has the disease? What about 15%? A lot of these pre-diagnostic decision making is not based in science, as History and Physicals are not sensitive or specific enough to make a clear judgment. In fact, as we have more electronic medical records, physician researchers are delving into the science of H&P's and realizing that our classical descriptions of many diseases are quite inaccurate.

To continue the question, what if the test costs $10,000? What if that test only has an 80% chance of detecting the disease? I hope everyone here realizes that very few tests in our medical arsenal is 100% sensitive (i.e. is always able to detect disease when disease is present) and none are 100% specific (is always able to say that a person has a disease when disease is present). Most tests fall into the 70-80% sensitivity and 70-80% specificity ranges. Good tests are in the 90% for both...but they are relatively rare.

Of course, each test carries a risk. CAT Scans with intravenous contrast, for instance, carries an approximate risk of 2% for developing renal failure. However, if you have diabetes, or are older in age, have anemia, and a lot of other medical issues, your risks could be as high as 30%. If your doctor orders this test for you and you are of high risk, and you develop contrast induced nephropathy and go on to developing complete renal failure (which means you are permanently a renal dialysis patient), do you sue your doctor for malpractice? Do you sue your doctor because he didn't weigh the risks of CIN versus the risks of not doing the test for that catastrophic illness?

Or, if your doctor did not order the test, then you die or are permanently injured as a result of that catastrophic illness, do you (or your survivors) sue the doctor for malpractice? How do you weigh the risks?

In the end, many, many physicians choose to order the test because at least in the eyes of the jury, it appears that the doctor was 'competent' and caring enough to order the test. Each test we order when we are fairly certain that the patient doesn't have an illness is an example of CYA.



To be fair, even when we know that a person has an illness (i.e. pneumonia), we order tests because if we didn't, the patients would likely call that physician a 'quack' and never return. It's a strange, strange business...



All I ever really needed to know, I learned from watching Star Trek.
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Re: Hospital Crisis and Obamacare
Posted by: Dennis S
Date: July 17, 2012 02:40PM
"Obamatax" - swampy

Good one, swampy. Did you get that from Rush or Hannity?
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Re: Hospital Crisis and Obamacare
Posted by: Acer
Date: July 17, 2012 02:56PM
I don't disagree that unreasonable malpractice actions exist, nor that defensive medicine is practiced, and I do agree that these areas can stand reform. But the numbers just don't add up to the level of crisis claimed.

"The cost of medical malpractice in the United States is $55.6 billion a year, which is 2.4 percent of annual health-care spending, a new study shows.

The researchers said their estimate includes $45.6 billion in what's known as defensive medicine costs -- when doctors prescribe unnecessary tests or treatments to avoid lawsuits."

[health.usnews.com]

Older article, feel free to find a better one.

Eliminating that 2.5% expense outright is just not going to make much difference. And relative to the income of the health care industry, this expense is not that big. Even doubling it by doubling Medicaid patients is not going affect the bottom line more than a relative blip.



Edited 1 time(s). Last edit at 07/17/2012 02:57PM by Acer.
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