Oversight of a physician sounds GREAT!!!  But then when you look closer, when you mandate that a service has to be provided by the guy with 500k in student loans that went to school for 7 years before doing 5 years of residency you understand why it exponentially increases the cost of getting a routine prescription updated. 

 

Also the greatest mitigating factor for cost is consumer choice.  The current system allows certain state markets to have a single option for service.  That's the death nil for consumers.  Allowing competition across state lines increases the available competition and thus the quality of the product for the consumer.  If you want to have common sense basic regulations then that's fine, but creating 50 artificial monopolies isn't going to help anyone. 

Medical school cost is an issue, and might be one of the factors B2hibry was talking about in an earlier post. I think that any solution that would involve decreasing doctor's incomes would have to take that into account. 

Regarding interstate competition, while I have heard some comments about the competition decreasing cost, I haven't really seen any detailed support for it. Do you have any support for the claim that it is the greatest factor? Also, why didn't it work in Georgia?

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<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

yes 2 to 11% of direct cost sounds correct. Its the hidden cost of extra tests and screens run. It cannot be exactly determined. But notice your estimate of 'defensive medicine' 45 billion.

 

Consider this: "the American Academy of Orthopedic Surgeons cited estimates that, by reducing defensive medicine, liability reform could result in yearly savings from $54 billion to $650 billion."

Source: http://medicaleconomics.modernmedicine.c...e-medicine

 

Also this from Jackson Healthcare: ""If physician estimates are accurate, this means that $650-850 billion per year is spent on lawsuit-driven medicine." Once again about 30 - 34%.

http://www.jacksonhealthcare.com/media-r...lease.aspx

 

That is about a third the cost of healthcare. Personally I believe that it is more like 40-50% total and a majority of tests are done defensively. It goes far beyond just the 'lawsuit.'

 

I read the JAMA article that the lower estimate comes from. They were fairly selective in their methodology and only included what they called 100% defensive. You can't do that. Its a false low.

Awesome, will try to check those out tomorrow. 

---

<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

Well, I can certainly see that when a for-profit company can use a 'Medicare did it' justification to cut costs they might be on that like catnip, but I meant the relationship of all other charges to Medicare. I am not sure I am reading it right, but it looks like there might be a 2.5X average excess compared to medicare rates as opposed to other charges in this JAMA article, and I have seen elsewhere reports of standard 500% markups in different specialties compared to Medicare schedules. I am not an expert on this stuff, and find it rather confusing. I remember back in the dark ages I worked for a truckine. Tariffs had to be published(I believe with the ICC). It seems a shame that there doesn't seem to be any transparency regarding health care rates. 

So hospitals mark up the cost of care to insurance and they bicker back and forth. What usually happens is the insurance has a pre-negiotiated rate that is not the 'sticker price' but the patients with coinsurance still end up paying a percentage of 'sticker' even tho they are not supposed to (cause they are supposed to pay 20%, but if I pay 20% of $500 and my insurance pays $100 I really just paid 50% of the cost). This is less of a thing with individual providers and more with hospitals as a system. 

 

With medicare its different. The hospital will bill medicare its rate and then medicare decides it is only going to pay 60%. So the insurance see what medicare pays and try to get that same deal. But you as an individual cannot get that deal. But the hospitals also use the markups to cover costs from non-paying patients. Say a person couldn't afford a surgery at all (sticker or reduced). If the hospital decides to take a loss (which happens more often then people think like 10-20% of surgerys), the hospital says that they couldn't afford the sticker price of the surgery in order to use it to decrease profits etc. So instead of you not being able to afford a 5000 gallbladder removal (just pretend thats the 'real price') they say you couldn't afford a 25k or 35k gallbladder removal. Anyway that is my understanding as a cog in the system.

---

Yes, it's improvement, but it's Blaine Gabbert 2012 level improvement. - Pirkster

http://youtu.be/ouGM3NWpjxk The Home Hypnotist!

http://youtu.be/XQRFkn0Ly3A Media on the Brain Link!
 

Peyton must store oxygen in that forehead of his. No way I'd still be alive after all that choking.

 

Samjag, I do not necessarily disagree with you, but your point totally ignores the fact that expected medical expenses includes drugs for conditions that patients had most or all of their lives. I can only use my own situation as an example, so please don't think I am being selfish. Millions of Americans are in the same boat.

 

I have epilepsy. Treatment is two drugs - one twice a day, the other once a day. Both drugs are unaffordable despite being on the formulary for my health insurance plan. The only way to get them is free from the manufacturers. Luckily I qualified for that, but why should it be necessary when the drug are covered? Mom said the problem was she "fell into the doughnut hole." Although the doughnut hole is still legal I felt like I was scammed because the insurance companies Mom talked to gave her misinformation when she was shopping for a cheaper plan.

 

She also told me the price difference for regular vs. extended release forms of the same drug is ridiculously high. If I could take the regular version of my drugs, they would be dirt cheap. But I medically require an extended release prescription - otherwise I would get seizures before it was time to take my next dose. What an ACA replacement bill needs (I accept the fact there will be one) is a mandate to make all forms of a drug the same price - or at least a low cap on the price difference - so people don't see medication costs soar out of control just by getting new prescriptions.

Well I can't address everything in a short post, I'm sorry to hear about your epilepsy, I've seen how debilitating that can be. 

 

When you say that both drugs are unaffordable despite being covered on the insurance plan, are you saying that the copay on them is so high that they are unaffordable? I've seen that happen before. 

I remember hearing them promise that the ACA would close the Donut hole but you know how government promises go eh?

 

Given that the government is full of a bunch lying scam artists are crooks, I am not sure that Soviet style price controls are a solution either. You may be able to set price controls on an item in the short term, but you aren't actually lowering the cost of the item, you are only distorting the market for it and that plays out in the unintended consequences. 

 

The cost of the extended release tablets is super high only because that cost is getting paid somehow. If they weren't getting that price for the drug, they wouldn't be selling it that high. I doubt that the incredibly wealthy have far more epilepsy than the average Joe and are just shelling out massive amounts of money for this extended release drug, so someone is paying that bill--probably either the government or the insurance company. They are distorting the price and the market for that drug. Perhaps there is another insurer that would cover more of the cost of that rx? I'd bet if you weren't buying it through the insurance, the actual final cost of the drug would not be the same at all. When insurance is paying, why charge $5 when you can charge 20 and they still pay? Same deal with the government, that's why they pay $500 for a hammer or $10,000 for a toilet seat. It is all market distortion. 

 

What if we had a law that said that a pharmacy or pharma company cannot charge different rates to different customers? If you and I were both in line at the Walgreens and we're both getting the prescription XYZ-ER and they tell you it's $750 and they tell me it's $150, that's some bullpucky, but that's what they are doing. They say o ok 80% of your $750 is covered by your insurance, so you pay $150 out of pocket----you paid the same out of pocket as me, but you got ripped off cause you pay for your insurance too. They inflate the price to make it look like the insurance has saved you money when it hasn't. 

---

Calling Deshawn Watson a future bust since 3/19/17. If I eat crow, I will keep this in here and proclaim JackCity a genius. 

There are great health care systems around the world to get ideas from. It's good to know I will still get good health care if I lose my job.

---

1) You assume the state government is the only barrier to entry. It may simply not make financial sense to build a hospital. There may be no demand for one. 

 

2) Not sure why you wouldn't want the oversight of a physician. They are your primary healthcare provider. 

 

3) There is a good reason they don't sell across state lines. Insurers would cherry pick where they provided business, potentially to the states with the healthiest populations. This would create a race to the bottom as insurers would get to choose both their regulator and their risk pool. 

 

1. Here in Jacksonville 3 health care systems have been fighting over who gets to build a hospital in the Southwest area of the region. St. Vincent's, Baptist and HCA all applied for a CON to build but St Vs was approved and the other two told they couldn't build. Demand is irrelevant, the government decides who does and doesn't get to build their facilities in that neighborhood. Here's an article about the Baptist denial and the reasons outlined for telling them no.

 

http://jacksonville.com/community/clay/2...y-hospital

 

2. There are dozens of minor health care issues that we currently use physicians for that could be accomplished without their oversight. The cost of becoming a physician and the salary and benefits of being one means that they as a whole are ragingly protective of their market share and territory. As a result we now have a severe shortage of providers at every level because doctors do work that doesn't require them and we strangle the supply from medical schools.

 

3. Insurers already do that by how they contract with health systems and physicians and by choosing to leave states entirely. As always happens when government is involved, we have a huge bureaucracy full of redundancy and red tape that drives prices upward with a crippling effect on the service.

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Well I can't address everything in a short post, I'm sorry to hear about your epilepsy, I've seen how debilitating that can be. 

 

When you say that both drugs are unaffordable despite being covered on the insurance plan, are you saying that the copay on them is so high that they are unaffordable? I've seen that happen before. 

I remember hearing them promise that the ACA would close the Donut hole but you know how government promises go eh?

 

Given that the government is full of a bunch lying scam artists are crooks, I am not sure that Soviet style price controls are a solution either. You may be able to set price controls on an item in the short term, but you aren't actually lowering the cost of the item, you are only distorting the market for it and that plays out in the unintended consequences. 

 

The cost of the extended release tablets is super high only because that cost is getting paid somehow. If they weren't getting that price for the drug, they wouldn't be selling it that high. I doubt that the incredibly wealthy have far more epilepsy than the average Joe and are just shelling out massive amounts of money for this extended release drug, so someone is paying that bill--probably either the government or the insurance company. They are distorting the price and the market for that drug. Perhaps there is another insurer that would cover more of the cost of that rx? I'd bet if you weren't buying it through the insurance, the actual final cost of the drug would not be the same at all. When insurance is paying, why charge $5 when you can charge 20 and they still pay? Same deal with the government, that's why they pay $500 for a hammer or $10,000 for a toilet seat. It is all market distortion. 

 

What if we had a law that said that a pharmacy or pharma company cannot charge different rates to different customers? If you and I were both in line at the Walgreens and we're both getting the prescription XYZ-ER and they tell you it's $750 and they tell me it's $150, that's some bullpucky, but that's what they are doing. They say o ok 80% of your $750 is covered by your insurance, so you pay $150 out of pocket----you paid the same out of pocket as me, but you got ripped off cause you pay for your insurance too. They inflate the price to make it look like the insurance has saved you money when it hasn't. 

 

Actually you're wrong about pricing. It's against the law for any health care entity, pharmacy included, to price their drugs or services differently because of the insurance status of the customer. They can contract with insurance for lower reimbursement, but they cannot have a different list price, it has to be the same all the time. What's different is the amount of the contractual discounts from that price, those vary payer to payer and even contract to contract from the same payer.

 

Additionally, drug costs are reimbursed by insurance companies based on the Average Wholesale Price document produced by CMS each quarter. Most contracts are set in stone at the AWP so you don't negotiate them, you just get paid what the document says plus a small percentage. If the pharmacy is giving you a number it's the out of pocket expense which varies, not the shelf or list price because that really doesn't.

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

1) I actually agree with this somewhat. Thats why you see the proliferation of stand alone ER's (cause no certificate of need required). 

 

Stand alone ERs are designed to do one critical thing: capture geography. You place SAERs into the parts of town where Rescue would not otherwise be able to select your hospital as a primary destination when the call requires the closest available facility. Once the patient is there and you stabilize him/her then you transport them to your hospital to capture the admission. Yes, they are easier to license, but they have a very specific strategic purpose.

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

 

With medicare its different. The hospital will bill medicare its rate and then medicare decides it is only going to pay 60%. 

 

It's the opposite, Medicare establishes the fee schedule each year in October and implements it January 1st, then most groups make their adjustments to their fee schedules for January implementation. 

 

Insurance contracts generally run 2 to 4 years and are based on some formula of a particular year of the Medicare fee schedule. For instance, Aetna will negotiate this year for a 3 year deal that pays 104% of the 2015 year Medicare fee schedule. Any new codes that are added by Medicare are addressed by contract language that spells out how Aetna will pay them, usually at a lower rate that the 104% they've agreed to for established codes. Contract rates aren't uaually affected by the annual Medicare changes except in which codes are new and which ones are no longer valid.

 

For anyone who cares, the Medicare Fee Schedule is comprised of procedure codes that identify the service performed by the provider. The procedure codes are linked to diagnosis codes that must be present for the procedure to meet "medical necessity." The codes are priced by what's called Relative Value Units, or RVUs. These RVUs are made up of 3 components: the work RVU, the expense RVU and the malpractice RVU. The RVU is mulitplied by a Geographic Adjustment Factor that exists to balance the differences in operating cost by region of the country. For instance, the GAF is higher in New York City than in Birmingham, Alabama because of thedifferences in the cost of living.

 

As JackCity was asking about cost, the answer for professional services (doctors and other clinicians) is that Medicare pays for each level of service based on the RVUs assigned to the service code the physician provides. Your doc sees you for a cold, bills Medicare a 99213 code for the office visit and Medicare pays $73.93 nationally for the service when provided outside a facility. The regional Medicare contractor who processes your claim then applies the GAF and you end up with a higher or lower amount based on where you are located. Where I work that number is $73.17. That's the results of all that math I described up above. 

 

Facilities have differing rates because their overhead is structured differently. Most hospital stays are paid using Diagnosis Related Groups (DRGs) to calculate the cost. As mentioned above, the reimbursement for a Gall Bladder surgery for a facility is the CMS calculation of the RVUs of that procedure and all the supportive and ancillary care that goes with it. The facility is paid a flat rate for the DRG and has to made due with that amount. Again, the amount paid is calculated by the government and then that number is used by the commercial plans for negotiation. 

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

So hospitals mark up the cost of care to insurance and they bicker back and forth. What usually happens is the insurance has a pre-negiotiated rate that is not the 'sticker price' but the patients with coinsurance still end up paying a percentage of 'sticker' even tho they are not supposed to (cause they are supposed to pay 20%, but if I pay 20% of $500 and my insurance pays $100 I really just paid 50% of the cost). This is less of a thing with individual providers and more with hospitals as a system. 

 

With medicare its different. The hospital will bill medicare its rate and then medicare decides it is only going to pay 60%. So the insurance see what medicare pays and try to get that same deal. But you as an individual cannot get that deal. But the hospitals also use the markups to cover costs from non-paying patients. Say a person couldn't afford a surgery at all (sticker or reduced). If the hospital decides to take a loss (which happens more often then people think like 10-20% of surgerys), the hospital says that they couldn't afford the sticker price of the surgery in order to use it to decrease profits etc. So instead of you not being able to afford a 5000 gallbladder removal (just pretend thats the 'real price') they say you couldn't afford a 25k or 35k gallbladder removal. Anyway that is my understanding as a cog in the system.

 

That's what I've seen. The providers and the insurance companies are gaming the system. The whole concept of insurance is part of the problem, since it's really not insurance against catastrophe, but an unlimited use fee. Medical costs would be a lot lower if people paid out of their own pockets and insurance just covered catastrophic problems. There's no competition for price when insurance companies just follow Medicare price controls.


To answer the original question, here are some ideas:


 

1. The ACA should be scrapped, completely. It's too flawed to fix.


 

2. Most company-provided insurance will cover pre-existing conditions if the person had prior coverage when the condition was discovered. This is a reasonable thing to codify into law.


3. Individuals should get full tax credit for heath care costs including insurance. Corporations should pay no taxes (the customers actually pay the taxes through higher prices anyway), so a corporate tax write off would not be a factor. This would move the responsibility for health insurance to the individual, resulting in more competition and lower rates.


4. Eliminate the requirement that hospitals have to treat non-citizens. Health insurance costs in California are way higher than they are in Florida for this very reason.


 

5. Make most drugs non-prescription. That would eliminate numerous otherwise unnecessary trips to the doctor. Amoxicillin for childhood ear infections is a prime example of this. It was absurd that Prilosec was suddenly found out to be safe as a non-prescription drug just as the patent expired.


6. The US should limit the drug prices to the lowest price a company charges among the ten highest GDP countries where a drug is sold. If a company claims it can't sell the drug profitably at that price, then they can raise the price elsewhere (or not sell it there if the other country balks at an increase) to compensate.

---

                                                                          

"Why should I give information to you when all you want to do is find something wrong with it?"

VA

I think SolidSnake might have been talking more of a Medicare-type setup, sort of a NHI model with the government leveraging purchasing power, but I am not sure.. VA is more like the Beveridge model. 

---

<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

Actually you're wrong about pricing. It's against the law for any health care entity, pharmacy included, to price their drugs or services differently because of the insurance status of the customer. They can contract with insurance for lower reimbursement, but they cannot have a different list price, it has to be the same all the time. What's different is the amount of the contractual discounts from that price, those vary payer to payer and even contract to contract from the same payer.

 

Additionally, drug costs are reimbursed by insurance companies based on the Average Wholesale Price document produced by CMS each quarter. Most contracts are set in stone at the AWP so you don't negotiate them, you just get paid what the document says plus a small percentage. If the pharmacy is giving you a number it's the out of pocket expense which varies, not the shelf or list price because that really doesn't.

No offense, but how is the bolded part above not just a matter of semantics. If the actual price is different, what does a bogus 'list price' matter? If anything it seems to support the idea of price distortion Samjag was talking about. 

 

Any source for the second part in bold? It was my understanding that AWP did not apply to volume discounts, rebates etc, and that it was nowhere near as universal as you seem to state.

---

<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

It's the opposite, Medicare establishes the fee schedule each year in October and implements it January 1st, then most groups make their adjustments to their fee schedules for January implementation. 

 

Insurance contracts generally run 2 to 4 years and are based on some formula of a particular year of the Medicare fee schedule. For instance, Aetna will negotiate this year for a 3 year deal that pays 104% of the 2015 year Medicare fee schedule. Any new codes that are added by Medicare are addressed by contract language that spells out how Aetna will pay them, usually at a lower rate that the 104% they've agreed to for established codes. Contract rates aren't uaually affected by the annual Medicare changes except in which codes are new and which ones are no longer valid.

 

For anyone who cares, the Medicare Fee Schedule is comprised of procedure codes that identify the service performed by the provider. The procedure codes are linked to diagnosis codes that must be present for the procedure to meet "medical necessity." The codes are priced by what's called Relative Value Units, or RVUs. These RVUs are made up of 3 components: the work RVU, the expense RVU and the malpractice RVU. The RVU is mulitplied by a Geographic Adjustment Factor that exists to balance the differences in operating cost by region of the country. For instance, the GAF is higher in New York City than in Birmingham, Alabama because of thedifferences in the cost of living.

 

As JackCity was asking about cost, the answer for professional services (doctors and other clinicians) is that Medicare pays for each level of service based on the RVUs assigned to the service code the physician provides. Your doc sees you for a cold, bills Medicare a 99213 code for the office visit and Medicare pays $73.93 nationally for the service when provided outside a facility. The regional Medicare contractor who processes your claim then applies the GAF and you end up with a higher or lower amount based on where you are located. Where I work that number is $73.17. That's the results of all that math I described up above. 

 

Facilities have differing rates because their overhead is structured differently. Most hospital stays are paid using Diagnosis Related Groups (DRGs) to calculate the cost. As mentioned above, the reimbursement for a Gall Bladder surgery for a facility is the CMS calculation of the RVUs of that procedure and all the supportive and ancillary care that goes with it. The facility is paid a flat rate for the DRG and has to made due with that amount. Again, the amount paid is calculated by the government and then that number is used by the commercial plans for negotiation. 

Great info, thanks. Do you have any thoughts on the relative administrative costs of Medicare versus private insurance?

---

<p class="bbc_left">Education is the cheap defense of nations. - Edmund Burke

<p class="bbc_left"> 

<p class="bbc_left">Or is it from Burke? I tried finding the source, and looked through some of his writings, no luck. Anybody with google-fu got a citation of the source?

Strong contract law prevents that from happening. It's one of the few true purposes of government to enforce them.

except they really dont...every filed an appeal for denial of services? you can expect to wait for months before they take any action...I need an MRI for my back but to get an MRI I have to either attend pain management sessions or physical therapy for 6 weeks...I waited 2 weeks for an opening in pain management only for them to tell me I can't do pain management without having an MRI, so I waited another week for an opening in physical therapy who said they can't treat me because I need a firm diagnoses of my condition because they don't want to cause more damage to my back by doing the wrong exercises, so I can't do psychical  therapy without an MRI...Filed an appeal, about 6 weeks later the insurance company claimed it's not a medical necessity at this time because they have found that physical therapy often relieves back pain without the need for an MRI, so it went back to the arbitration board...  

---

When does personal responsibility kick in? Why even with ACA are there so many not covered? This is where we see that big lie in the sky exposed: insured versus covered. Affordability comes with competition and that isn't happenening. But more importantly, pharma needs to be slapped down a notch or two. That is one of the largest costs most times.

I know quite a few people who did not sign up for/with the ACA because it is expensive with a very high deductible so it's cheaper to pay the fine for not being insured than it is to have insurance through the ACA

---

That's what I've seen. The providers and the insurance companies are gaming the system. The whole concept of insurance is part of the problem, since it's really not insurance against catastrophe, but an unlimited use fee. Medical costs would be a lot lower if people paid out of their own pockets and insurance just covered catastrophic problems. There's no competition for price when insurance companies just follow Medicare price controls.


To answer the original question, here are some ideas:


1. The ACA should be scrapped, completely. It's too flawed to fix.


2. Most company-provided insurance will cover pre-existing conditions if the person had prior coverage when the condition was discovered. This is a reasonable thing to codify into law.

3. Individuals should get full tax credit for heath care costs including insurance. Corporations should pay no taxes (the customers actually pay the taxes through higher prices anyway), so a corporate tax write off would not be a factor. This would move the responsibility for health insurance to the individual, resulting in more competition and lower rates.


4. Eliminate the requirement that hospitals have to treat non-citizens. Health insurance costs in California are way higher than they are in Florida for this very reason.


5. Make most drugs non-prescription. That would eliminate numerous otherwise unnecessary trips to the doctor. Amoxicillin for childhood ear infections is a prime example of this. It was absurd that Prilosec was suddenly found out to be safe as a non-prescription drug just as the patent expired.


6. The US should limit the drug prices to the lowest price a company charges among the ten highest GDP countries where a drug is sold. If a company claims it can't sell the drug profitably at that price, then they can raise the price elsewhere (or not sell it there if the other country balks at an increase) to compensate.

5. Make most drugs non-prescription. That would eliminate numerous otherwise unnecessary trips to the doctor. Amoxicillin for childhood ear infections is a prime example of this. It was absurd that Prilosec was suddenly found out to be safe as a non-prescription drug just as the patent expired.


Absolutely not. Amoxicillin is already over prescribed as it is, and now you want to grant the ordinary citizen the ability to treat their own bacterial infections. Sounds like a disaster waiting to happen. We already have a antibiotic resistance crisis. Let's pour gasoline on the fire. No.

---

I actually agree here. It is crazy that the long acting form of many drugs is so much more expensive. I mean I can understand a little more cost for the convenience but still.

 

I know. It makes no sense because both the regular and XR forms are pills that must be swallowed whole. Something else that drove me insane was the price difference for 100 and 300 mg pills. I take three 100s because of insurance. What is wrong with taking one 300 mg pill?

---

5. Make most drugs non-prescription. That would eliminate numerous otherwise unnecessary trips to the doctor. Amoxicillin for childhood ear infections is a prime example of this. It was absurd that Prilosec was suddenly found out to be safe as a non-prescription drug just as the patent expired.


Absolutely not. Amoxicillin is already over prescribed as it is, and now you want to grant the ordinary citizen the ability to treat their own bacterial infections. Sounds like a disaster waiting to happen. We already have a antibiotic resistance crisis. Let's pour gasoline on the fire. No.

I agree with this regarding antibiotics. But I think an ARNP can make that diagnosis independent of a physician.

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

except they really dont...every filed an appeal for denial of services? you can expect to wait for months before they take any action...I need an MRI for my back but to get an MRI I have to either attend pain management sessions or physical therapy for 6 weeks...I waited 2 weeks for an opening in pain management only for them to tell me I can't do pain management without having an MRI, so I waited another week for an opening in physical therapy who said they can't treat me because I need a firm diagnoses of my condition because they don't want to cause more damage to my back by doing the wrong exercises, so I can't do psychical  therapy without an MRI...Filed an appeal, about 6 weeks later the insurance company claimed it's not a medical necessity at this time because they have found that physical therapy often relieves back pain without the need for an MRI, so it went back to the arbitration board...  

 

This reminds me of Dad complaining to Mom about needing to take a CAT scan to see if he needed a PET scan. The PET scan revealed his colon cancer was in Stage 4. Why can't the insurance company simply pay for the PET scan? Before that test, the doctor thought it was in Stage 1, so without knowing any better I blamed the insurance company for making him put off having surgery too long.

---

Stand alone ERs are designed to do one critical thing: capture geography. You place SAERs into the parts of town where Rescue would not otherwise be able to select your hospital as a primary destination when the call requires the closest available facility. Once the patient is there and you stabilize him/her then you transport them to your hospital to capture the admission. Yes, they are easier to license, but they have a very specific strategic purpose.

You got it.

---

Yes, it's improvement, but it's Blaine Gabbert 2012 level improvement. - Pirkster

http://youtu.be/ouGM3NWpjxk The Home Hypnotist!

http://youtu.be/XQRFkn0Ly3A Media on the Brain Link!
 

Peyton must store oxygen in that forehead of his. No way I'd still be alive after all that choking.