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growlers

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  1. “Building fancier buildings” we don’t build buildings and we don’t refer tests out to our “cronies” or whatever term the conspiracy people want to use. ER doctors work in ERs, they are in hospitals. We don’t build them. I’m unaware of any ER group in the entire country who has actually built an ER. I likely don’t know your friend, but I know literally hundreds of ER doctors and none of them get paid based on the number of tests they order. In fact we are getting constantly pressured by the hospitals and government to order less tests and admit less patients, due to various compensation pressures placed by the government. Which I think is overall good btw, I am in favor of universal healthcare in fact as I think it is the ethical and moral thing to do as a country I work in a reasonably honorable group that is a division of a notoriously scummy massive company that contracts with somewhat predatory for-profit hospitals. I’m not in some weird bubble. So i think I have a reasonable understanding of the compensation patterns for the vast majority of ER doctors despite the anecdotal opinions in the thread.
  2. You have no clue. I am an ER doctor and your accusations are frankly offensive given I just got home after seeing 35 patients, quite a few of which won’t pay a dime (and I frankly don’t care because I/ my partners are there 24/7 365/year to save lives regardless of money, race, citizenship or anything else, I consider it a privilege not a paycheck) “they did all those tests to rack up the bill.” When I see an ER patient I have no idea what insurance they have, if any. We don’t get extra money for ordering more tests. It’s much more work for me to order a bunch of tests and you know, actually care, than it is to kick you out door with no testing. I’m glad you already knew he didn’t need any of those tests and “just needed to rest”. Maybe next time don’t waste my time in the ER and call an ambulance if you already know all the answers and have X-ray vision and hopefully you aren’t wrong and he dies of a brain bleed at home. You have no idea what the indications are for a head ct in a pediatric head injury and don’t have the experience of taking care of literally a thousand head injuries, and many many brain bleeds and skull fractures. So for you to sit here and say that because they were negative that they were unnecessary and that the doctor ordered them to rack up the bill is infuriating. Also, if they didn’t order them and missed your kids bleed you would immediately start a thread about home some careless evil doctor killed your kid and your immediate lawsuit. Get bent.
  3. I look at this and don’t understand why we don’t just have universal health care.
  4. Premium only went up maybe 10% but became more network restrictive. I can get away with that fairly easily as I’m a doc and have all sorts of work arounds if needed. i don’t actually get the policy off an “exchange” per se, but the individual policy I have didn’t exist before the ACA it’s been totally a life changing positive for me, but I feel like I don’t show up in these quoted “stats” as being someone who benefitted massively because of the flexibility made possible by the ACA, seems misleading
  5. I had employer sponsored coverage until 2016. I was working full time, partly because with a history of spine problems and hypertension I couldn’t get any individual insurance plan so had to stay full time to keep my insurance. When Obamacare came out, it allowed me to go part time and get an individual HSA plan. I didn’t go part time for any health issue, but Obamacare allowed me to have that option for other reasons. I get no subsidy due to high income but got an individual policy that didn’t exist except because of Obamacare. So I am a massive Obamacare fan but don’t actually have a policy off the exchange per se. Do I show up in any of these statistics? I can’t be the only one in this situation.
  6. Personally, I used to have insurance through my employer. Because of the ACA getting rid of the preexisting conditions issue I was able to finally get insurance as an individual. This allowed me to go part time, so even though I didn’t get my plan off the exchange and don’t get a subsidy the ACA was huge for me
  7. i hate to break this to ya' but when the pharmacy tech at walgreens is tapping on the computer to see what your copay is, the insurance company isn't instantly downloading and analyzing your healthcare record to see if the Rx meets CDC guidelines the amount of misinformation in the this thread is mind boggling, I'm going back to only lurking medical threads
  8. Tamiflu is commonly given to anyone with symptoms <48 hours regardless of risk category, CDC guidelines support this https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm Summary of Influenza Antiviral Treatment Recommendations Clinical trials and observational data show that early antiviral treatment can shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza (e.g., otitis media in young children, pneumonia, and respiratory failure). Early treatment of hospitalized adult influenza patients has been reported to reduce death. In hospitalized children, early antiviral treatment has been reported to shorten the duration of hospitalization. Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset. Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who: is hospitalized; has severe, complicated, or progressive illness; or is at higher risk for influenza complications. Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.
  9. sigh. I have mixed feelings about tamiflu's costs vs benefit ratio (and I don't just mean $$$ - I mean money and side effects and promotion of resistance, etc) and while there is controversy among medical experts about when it should and when it should not be used - this statement is clearly wrong. I'm not gonna google an exact # but I would bet large amounts of money that >95% of tamiflu is prescribed for outpatients- so saying that tamiflu should only be used in immunosuppressed or sick hospitalized patients is clearly wrong and not in line with CDC guidelines or the current national standard of practice
  10. This is 100% wrong. They aren’t denying the healthcare service, they are just denying payment of it. Why do you think they require peeauthorization for certain testing? They deny tests all the time. They deny prescription meds all the time. Then the doctors office at their expense has to appeal. Outpatient doctors groups have staff that all they do is file preauthorization forms and appeals. They literally are getting paid out of the groups refenue to just deal with this crap. The big reason why you see docs move to concierge fee practices is overhead costs of dealing with insurance issues
  11. I’ll 100% agree that there are massive problems with charges and billing. But please don’t compare the costs to provide a : 1) scheduled Chest x-ray at an imaging center that is run 8-5 Monday through Friday with relatively low operating costs and who won’t even let a patient in the door without payment and a radiologist who is not even on site and reads it the next day 2) to an ER charge for a chest X-ray where the person may arrive with no notice at 2 am on Christmas morning intubated and there is 24/7 X-ray tech who does the film with a portable machine and sends it to a radiologist who is up all night reading films and gets me the result 5 minutes later, in a patient that we don’t even have their name let alone any assurance of being eventually paid 3 months later meanwhile you have to have the capacity available to see dozens of other patients simultaneously so it’s not like you can just staff with one X-ray tech
  12. Im not trying to pick on you, and I’m trying to restrain myself here, but this is completely misleading. Your link is to a lobbying page of the health insurance industry. You need to vet your sources better Worse, that webpage also states that there is 17.8% operating costs. The 3.5 cents you quote is their PROFIT. So really the insurance company is taking over 20% of every health care dollar. Not a single cent of that is any actual healthcare. It’s just a big machine taking 20% of all dollars out of the system.
  13. agreed that there are criminals that steal in an industry that is like a fifth of the US economy there are laws against kickbacks if they catch you then you go to jail and lose your license i'll be happy to lock their jail door But those links actually prove my point that individual doctors don't get kickbacks for testing!!! edit: the be clear, meaning the fact that is a news-worthy crime means that it's illegal and not an industry practice. It's interesting to me that probably 80% of people think that doctors get paid for each test that order.
  14. to be clear i was talking about the emergency department not private offices, i'm only referencing ER visits ER doc gets ZERO financial benefit from ordering an individual test Hospitals generally discourage imaging utilization not encourage it because most payments are bundled so no INDIVIDUAL imaging test makes them money on an admitted patient, in my experience hospitals penalize docs who order more tests in the ER and inpatient beds they certainly don't encourage it not as clear cut for outpatient encounters, depends on the hospital system, insurance network, many factors
  15. in my experience as a patient they are checking to find out which imaging center takes my insurance and has the lowest copay for they test they are ordering it's not like they get a kickback from the lab center or imaging center they send me to