yzerman19 Posted March 7, 2014 Share Posted March 7, 2014 Getting back to the RVU and CF this is why you have primary care providers, pediatricians and family practice docs as examples, seeing patients every 10-15 minutes. More RVU volume to offset the much lower CF as compared to their subspecialty/surgeon counterparts whose CF is at a much higher dollar amount per RVU. magnified by more RVUs for the procedures the specialists perform. A specialist can earn/produce more RVUs in the same time period, and be paid more per RVU. Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 Back on topic...anyone wonder why there is a rise in NPs and PAs practicing in the major helathcare systems? Let's say 58 yr. old Aunt Sally falls on the ice and winds up with a hip issue. Her insurance is NDBCBS. I'll give you possible scenarios within the same healthcare system...i.e Altru (not even going to go into the ER scenario): 1) She is seen in a clinic with a PA or NP...possibly in a Walk-In or Urgent Care setting 2) She gets in to see her PCP or internist 3) She is able to get into an ortho clinic to see a specilaist. In all 3 scenarios let's say all 3 providers bill the same CPT code for that encounter. In each scenario NDBCBS will pay the same amount for the visit or claim regardless of which provider she were to see. The system, in this example Altru but you could pick one, makes more money on the visit provided by the NP or PA, then the PCP then the specialist. Why? Again it goes back to the negotiated CF per RVU paid out to each provider. That's why systems try to push patients to primary care providers in a clincal setting, especially PAs or NPs, as their profit margin per encounter is greater. Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 magnified by more RVUs for the procedures the specialists perform. A specialist can earn/produce more RVUs in the same time period, and be paid more per RVU. Exactly. Quote Link to comment Share on other sites More sharing options...
jdub27 Posted March 7, 2014 Share Posted March 7, 2014 I hope Chicagolandsioux comes back and posts when Chicago and the state of ILL file for bankruptcy. Maybe they're just raise taxes again? Guessing he'll hear about it while sitting next to his pool in Arizona. Quote Link to comment Share on other sites More sharing options...
MafiaMan Posted March 7, 2014 Share Posted March 7, 2014 I hope Chicagolandsioux comes back and posts when Chicago and the state of ILL file for bankruptcy. Maybe they're just raise taxes again? Actually, I'm not sure chicagolandsioux is all that familiar with the state of Illinois... Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 Actually, I'm not sure chicagolandsioux is all that familiar with the state of Illinois... If you are talking about chicagolandsmokey the watchmaker...I agree. Quote Link to comment Share on other sites More sharing options...
MafiaMan Posted March 7, 2014 Share Posted March 7, 2014 Do you really enjoy paying a larger percentage of your income in taxes than Hamm and the oil companies you are supporting? Furthermore, being the tax is higher here than elsewhere why do they then keep drilling? I Know I Know! That is where the oil is. Though the people who pay little to no income tax pay a higher percentage of their income in taxes than you do. That is why the argument always stops at income taxes and not total taxes as a percentage of income. Because when that occurs the argument of who does not pay income taxes as talking point lose the argument. Nah...couldn't be... Quote Link to comment Share on other sites More sharing options...
wxman91 Posted March 7, 2014 Share Posted March 7, 2014 That argument that a higher % of total income is paid out in taxes by lower income households is BS. "Leftie propaganda"...right smokey?? I will say this again...the lower 20% of household incomes in this country pay roughly 16% of their overall income/dollars earned in federal, state and local taxes. This 20% is also in the bucket that pays a NEGATIVE 9% of the total income tax in this country. You understand the negative part?? Common sense for most people would have been to change their rhetoric and ramble when trying to reenter a message/opinion board and website under a different moniker... especially after getting the boot multiple times!! If you want to get tossed again from this site...I'll dance with you. I was under the impression that political posts on this message board were frowned upon, but given that this thread is still going... I think the argument that chicagoland is trying to clumsily make is that certain states, especially those with Republican legislatures, are trying to draw businesses in by scrapping corporate and income taxes in favor of sales taxes. This is an inherently regressive tax situation, where lower income folks are made to pay more in taxes while the burden is shifted away from higher income folks. While this does not overall mean that lower income folks are paying more overall in taxes due to the federal tax system, it does exacerbate the income gap and make lower income folks more reliant on government subsidies (be it food stamps, medicaid, welfare, disability, etc.). The other thing this does is perpetuate a "race to the bottom" mentality, whereby states vie for businesses by cutting them every break possible. While this may end up good for the state that gets the business, it is questionable (well, not so much in my mind) whether it is good for the country overall. The culture of business ownership has gone from stakeholder to shareowner, where profit is the only thing that matters. See the various activist shareholders in the news lately that demanded that some tech companies slash worker pay to increase share value. We go down this road, and see how pensions have been eliminated, profit sharing scratched, health insurance cut, and wages stagnant. The profit-at-all-costs culture is the very being of capitalism, but the result is what we have seen in this country - a redistribution of wealth from the poor to the rich. The simple fact is the fastest route to socialism is capitalism on steroids (and frankly, vice versa). What we should be striving for is a middle ground. That sweet spot is an open debate, but I lean left, and tend ot think that the social safety net is important and the best case scenario for health care is single-payer (not gov't run). My dream tax fix would be to eliminate the corporate income tax, but make all cap gains/investment income/dividends subject to the marginal rate. Preferred rates for already having money is the absolute worst part of the system right now. Quote Link to comment Share on other sites More sharing options...
BobIwabuchiFan Posted March 7, 2014 Share Posted March 7, 2014 Hospitals are trying to go against doctors because they look at doctors as a large expense to their operation, hence hospitals were on board with Obamacare because it will force physicians to take lower payments and hence lower income over their career and will force independent practices to move into the Hospital model for cost reasons. The shortage of doctors, particularly due to the Medical school limiting to ensure income, will be broken by the hospitals hiring physician assistants and nurse practitioners who deliver basic care at a higher profit margin. Ultimately, it won't make any sense for a doctor to be in basic care, but rather push higher into the specialties that cannot be easily substituted by less educated or certified individuals. If I was a doctor, then I would try as hard as hell to have a separate practice from a hospital because once you are in their grasp it will be hard to leave. I also agree its BS to not get deductions for school loans because I was wise enough to choose a profession in which I am paid well. Additionally, I paid my loans off early by 18 months, but again we don't incentivize this type of behavior so its an anomaly. Lastly, we need to have real shoppers when it comes to healthcare for a free market system to work...No one does any shopping when looking for medical services or rates, hence we all pay the same for varied outputs and inputs on behalf of the medical industry. I like the coverage until you are 26 and pre-existing conditions coverage in the AHA but that is it - we could have had these things without all of this partisan bickering from the start, but I still think we need to make the system more marketplace dependent and then we will see the power of competition and innovation to control costs and make the users of the system better shoppers. Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 I think the argument that chicagoland is trying to clumsily make is that certain states, especially those with Republican legislatures, are trying to draw businesses in by scrapping corporate and income taxes in favor of sales taxes. This is an inherently regressive tax situation, where lower income folks are made to pay more in taxes while the burden is shifted away from higher income folks. While this does not overall mean that lower income folks are paying more overall in taxes due to the federal tax system, it does exacerbate the income gap and make lower income folks more reliant on government subsidies (be it food stamps, medicaid, welfare, disability, etc.). The other thing this does is perpetuate a "race to the bottom" mentality, whereby states vie for businesses by cutting them every break possible. While this may end up good for the state that gets the business, it is questionable (well, not so much in my mind) whether it is good for the country overall. The culture of business ownership has gone from stakeholder to shareowner, where profit is the only thing that matters. See the various activist shareholders in the news lately that demanded that some tech companies slash worker pay to increase share value. We go down this road, and see how pensions have been eliminated, profit sharing scratched, health insurance cut, and wages stagnant. The profit-at-all-costs culture is the very being of capitalism, but the result is what we have seen in this country - a redistribution of wealth from the poor to the rich. The simple fact is the fastest route to socialism is capitalism on steroids (and frankly, vice versa). What we should be striving for is a middle ground. That sweet spot is an open debate, but I lean left, and tend ot think that the social safety net is important and the best case scenario for health care is single-payer (not gov't run). My dream tax fix would be to eliminate the corporate income tax, but make all cap gains/investment income/dividends subject to the marginal rate. Preferred rates for already having money is the absolute worst part of the system right now. You do make some very good points and some others I don't agree with but this isn't the place to really hash those out. But to ignorantly come here and paint with a broad brush that the "poor" pay a higher % of their income in taxes vs. the "rich" in this country is not factual in any way shape or form. One can cherry pick a state or use examples of sales tax, but the bottom line is one can not spin it to make the higher % of income paid in total taxes argument work for this country's population as a whole. Quote Link to comment Share on other sites More sharing options...
chicagolandsioux Posted March 7, 2014 Share Posted March 7, 2014 That argument that a higher % of total income is paid out in taxes by lower income households is BS. "Leftie propaganda"...right smokey?? I will say this again...the lower 20% of household incomes in this country pay roughly 16% of their overall income/dollars earned in federal, state and local taxes. This 20% is also in the bucket that pays a NEGATIVE 9% of the total income tax in this country. You understand the negative part?? Common sense for most people would have been to change their rhetoric and ramble when trying to reenter a message/opinion board and website under a different moniker... especially after getting the boot multiple times!! If you want to get tossed again from this site...I'll dance with you. Source your argument and I will source mine. You made this a political argument with your first post in this thread. Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 Source your argument and I will source mine. You made this a political argument with your first post in this thread. I'll set the under/over at 3 weeks before your stupid a** is tossed again. You aren't fooling anyone. You are a total JA under any moniker. Quote Link to comment Share on other sites More sharing options...
bigskyvikes Posted March 7, 2014 Share Posted March 7, 2014 Although the ACA is a mess, insurers are definitely taking advantage of it. "Hey, we can do whatever we want and if anyone questions the move, we can just blame Obamacare!" Bingo! Let me ask this to the others, if now us healthy people pay for the freeloaders, who do you think was paying for them before? Nothing has changed! Other than the fact rich companies raising rates, rich employers raising required employee payments, all in the name of......its not our fault its the ACA! Quote Link to comment Share on other sites More sharing options...
jdub27 Posted March 7, 2014 Share Posted March 7, 2014 I'll set the under/over at 3 weeks before your stupid a** is tossed again. You aren't fooling anyone. You are a total JA under any moniker. Third Fourth Fifth times a charm? Quote Link to comment Share on other sites More sharing options...
BobIwabuchiFan Posted March 7, 2014 Share Posted March 7, 2014 I was under the impression that political posts on this message board were frowned upon, but given that this thread is still going... I think the argument that chicagoland is trying to clumsily make is that certain states, especially those with Republican legislatures, are trying to draw businesses in by scrapping corporate and income taxes in favor of sales taxes. This is an inherently regressive tax situation, where lower income folks are made to pay more in taxes while the burden is shifted away from higher income folks. While this does not overall mean that lower income folks are paying more overall in taxes due to the federal tax system, it does exacerbate the income gap and make lower income folks more reliant on government subsidies (be it food stamps, medicaid, welfare, disability, etc.). The other thing this does is perpetuate a "race to the bottom" mentality, whereby states vie for businesses by cutting them every break possible. While this may end up good for the state that gets the business, it is questionable (well, not so much in my mind) whether it is good for the country overall. The culture of business ownership has gone from stakeholder to shareowner, where profit is the only thing that matters. See the various activist shareholders in the news lately that demanded that some tech companies slash worker pay to increase share value. We go down this road, and see how pensions have been eliminated, profit sharing scratched, health insurance cut, and wages stagnant. The profit-at-all-costs culture is the very being of capitalism, but the result is what we have seen in this country - a redistribution of wealth from the poor to the rich. The simple fact is the fastest route to socialism is capitalism on steroids (and frankly, vice versa). What we should be striving for is a middle ground. That sweet spot is an open debate, but I lean left, and tend ot think that the social safety net is important and the best case scenario for health care is single-payer (not gov't run). My dream tax fix would be to eliminate the corporate income tax, but make all cap gains/investment income/dividends subject to the marginal rate. Preferred rates for already having money is the absolute worst part of the system right now. I was under the impression that political posts on this message board were frowned upon, but given that this thread is still going... I think the argument that chicagoland is trying to clumsily make is that certain states, especially those with Republican legislatures, are trying to draw businesses in by scrapping corporate and income taxes in favor of sales taxes. No basis in reality...you are saying Blue states with Democrat governors aren't using tax breaks to lure industries into their state? This is an inherently regressive tax situation, where lower income folks are made to pay more in taxes while the burden is shifted away from higher income folks. While this does not overall mean that lower income folks are paying more overall in taxes due to the federal tax system, it does exacerbate the income gap and make lower income folks more reliant on government subsidies (be it food stamps, medic, welfare, disability, etc.). You then state its not regressive because the overall tax burden is positively weighed out in their favor when considering Earned Income Tax Credits on a Federal level - you also forget that the majority of these folks have avenues to add to their income and move out of poverty, but our perverted incentives tell people its no use and hence they stay where they are at - State of ND has jobs if people want to work, but the incentives given by the govt make that decision a no-brainer - whose fault is this? The Republicans? The other thing this does is perpetuate a "race to the bottom" mentality, whereby states vie for businesses by cutting them every break possible. While this may end up good for the state that gets the business, it is questionable (well, not so much in my mind) whether it is good for the country overall. The culture of business ownership has gone from stakeholder to shareowner, where profit is the only thing that matters. See the various activist shareholders in the news lately that demanded that some tech companies slash worker pay to increase share value. We go down this road, and see how pensions have been eliminated, profit sharing scratched, health insurance cut, and wages stagnant. The profit-at-all-costs culture is the very being of capitalism, but the result is what we have seen in this country - a redistribution of wealth from the poor to the rich. Profit is bad, socialism is good...we get it...You don't own a business and you don't understand why people who take risks and work harder than you should get more The simple fact is the fastest route to socialism is capitalism on steroids (and frankly, vice versa). What we should be striving for is a middle ground. That sweet spot is an open debate, but I lean left, and tend ot think that the social safety net is important and the best case scenario for health care is single-payer (not gov't run). My dream tax fix would be to eliminate the corporate income tax, but make all cap gains/investment income/dividends subject to the marginal rate. Preferred rates for already having money is the absolute worst part of the system right now. Where will all money come from for investment in the future with high risk? Do you think the government is a great picker of winners in the marketplace? Stocks and capital are huge advantages for the capitalist system and it doesn't come out of your paycheck either like Govt. subsidies would...The market picks the winners not the govt. Basically, I don't agree with anything you state... Quote Link to comment Share on other sites More sharing options...
yzerman19 Posted March 7, 2014 Share Posted March 7, 2014 Hospitals are trying to go against doctors because they look at doctors as a large expense to their operation, hence hospitals were on board with Obamacare because it will force physicians to take lower payments and hence lower income over their career and will force independent practices to move into the Hospital model for cost reasons. The shortage of doctors, particularly due to the Medical school limiting to ensure income, will be broken by the hospitals hiring physician assistants and nurse practitioners who deliver basic care at a higher profit margin. Ultimately, it won't make any sense for a doctor to be in basic care, but rather push higher into the specialties that cannot be easily substituted by less educated or certified individuals. If I was a doctor, then I would try as hard as hell to have a separate practice from a hospital because once you are in their grasp it will be hard to leave. I also agree its BS to not get deductions for school loans because I was wise enough to choose a profession in which I am paid well. Additionally, I paid my loans off early by 18 months, but again we don't incentivize this type of behavior so its an anomaly. Lastly, we need to have real shoppers when it comes to healthcare for a free market system to work...No one does any shopping when looking for medical services or rates, hence we all pay the same for varied outputs and inputs on behalf of the medical industry. I like the coverage until you are 26 and pre-existing conditions coverage in the AHA but that is it - we could have had these things without all of this partisan bickering from the start, but I still think we need to make the system more marketplace dependent and then we will see the power of competition and innovation to control costs and make the users of the system better shoppers. Historically, hospitals loved doctors, because they were the net that brought business to them. Build high-end specialty services with huge margins, cast a wide net of primary care, then reap the $$$ for all the admits and procedures. The fundamental challenge with market transparency is that the system is based on an incomprehensible matrix of retrospective coding, and payment is tied to the coding. I could, in theory, find out the reimbursement rate at a particular provider for say a 99213- let's say its $75. If I have a high deductible plan, I can then assume that the provider will probably bill about $150, they will accept $75 per the insurance contract, and I will owe all of the $75 assuming I haven't met my deductible. Easy right? Wrong. What if the physician finds something unusual or has to do some research into a medication interaction and it now warrants a 99214. Well now the reimbursement rate just went up to $100. Oh, and wait, a lab test needs to be ordered. That's another $30. Total owed is now $130 assuming I haven't met my deductible. I went it with the same problem...my throat hurts...I am paying $75 in one scenario and $130 in another scenario...with the same issue. That was a simple example...sore throat...now imagine it with something complicated Difference is $750 vs $1300 or much, much worse... Quote Link to comment Share on other sites More sharing options...
chicagolandsioux Posted March 7, 2014 Share Posted March 7, 2014 I'll set the under/over at 3 weeks before your stupid a** is tossed again. You aren't fooling anyone. You are a total JA under any moniker. http://www.ballpeoples.com/wp-content/uploads/2013/01/hctrendsandsolutions1.pdf http://usatoday30.usatoday.com/money/industries/health/2009-09-15-insurance-costs_N.htm http://www.ebri.org/pdf/programs/policyforums/Gabel1209PF.pdf http://www.beckersasc.com/asc-coding-billing-and-collections/blue-shield-of-california-expected-to-cut-many-premiums-by-25-in-2011.html Hey Oxbow where was your anger then? Quote Link to comment Share on other sites More sharing options...
chicagolandsioux Posted March 7, 2014 Share Posted March 7, 2014 You do make some very good points and some others I don't agree with but this isn't the place to really hash those out. But to ignorantly come here and paint with a broad brush that the "poor" pay a higher % of their income in taxes vs. the "rich" in this country is not factual in any way shape or form. One can cherry pick a state or use examples of sales tax, but the bottom line is one can not spin it to make the higher % of income paid in total taxes argument work for this country's population as a whole. Source your argument. Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 Source your argument. You seem to have a lot of free time so start by reading the Congressional Budget Office report that was released this past Decemeber. As far as anger...aren't you the one with a large supply of baseball bats?? Just asking........... Quote Link to comment Share on other sites More sharing options...
UNDBIZ Posted March 7, 2014 Share Posted March 7, 2014 Bingo! Let me ask this to the others, if now us healthy people pay for the freeloaders, who do you think was paying for them before? Nothing has changed! Other than the fact rich companies raising rates, rich employers raising required employee payments, all in the name of......its not our fault its the ACA! Finally. The ACA is certainly causing problems, but to deny that hospitals, insurers, big pharmaceuticals, and certain employers are taking advantage of it is foolish. Quote Link to comment Share on other sites More sharing options...
sprig Posted March 7, 2014 Share Posted March 7, 2014 Question for the doctors: Why, when you have a hospital XRay or similar, do 5+ Dr's bill for reading it? Does it take that many, do all actually look at it, or is just an administrative automatic billing for every dr. that worked there that day? Quote Link to comment Share on other sites More sharing options...
yzerman19 Posted March 7, 2014 Share Posted March 7, 2014 Question for the doctors: Why, when you have a hospital XRay or similar, do 5+ Dr's bill for reading it? Does it take that many, do all actually look at it, or is just an administrative automatic billing for every dr. that worked there that day? Not a doc, but depending on the situation it is usually only 2 or 3. There are situations where the bill will be broken into technical and professional component or kept packages as global. All doctors can read basic xrays, but radiologists are trained to look for everything. You want that oversight...many a person's life has been saved by a radiology overread- iding a cancerous spot that appeared in the image that was taken for an entirely different purpose. The cynic says the overreads are to protect against lawsuits. Also, unfortunately true. So, usually there are 2 professional reads of an xray. Might end up with 3 if an ER situation or an odd read. Quote Link to comment Share on other sites More sharing options...
yzerman19 Posted March 7, 2014 Share Posted March 7, 2014 Finally. The ACA is certainly causing problems, but to deny that hospitals, insurers, big pharmaceuticals, and certain employers are taking advantage of it is foolish. I want to know how insurers are taking advantage of it. I really want to hear the logic... Follow me on this: 1. Exchanges encourage transparent competition- forcing insurers to try and be price competitive 2. Actuarial value and MLR (80% on individual 85% on group) say that insurers can't price fix high 3. Benefit requirements and no underwriting and no maxes push costs up for providing coverage 4. Provider consolidation push costs up I could go on and on, but insurers are not taking advantage of anything here, they are on the ropes. Quote Link to comment Share on other sites More sharing options...
Oxbow6 Posted March 7, 2014 Share Posted March 7, 2014 Not a doc, but depending on the situation it is usually only 2 or 3. There are situations where the bill will be broken into technical and professional component or kept packages as global. All doctors can read basic xrays, but radiologists are trained to look for everything. You want that oversight...many a person's life has been saved by a radiology overread- iding a cancerous spot that appeared in the image that was taken for an entirely different purpose. The cynic says the overreads are to protect against lawsuits. Also, unfortunately true. So, usually there are 2 professional reads of an xray. Might end up with 3 if an ER situation or an odd read. Again well said and correct. He is the smart one...really smart. To dumb it down again... I'm not as smart...healthcare is not a combo meal or happy meal. Everything done for or to a patient and I mean everything is billed ala carte. Also most systems accept many many insurances. And the fees set for every single CPT code, lab, imaging test and procedures are set at a dollar level, generally, not to leave a reimbursable penny one the table. Let's say Sanford takes 100 different insurance plans. Someone like yzermam19 will find what is the top dollar paid by these 100 plans for every possible billable code and set the fee higher. If a one plan will reimburse a 99214 code at $100 and the other 99 reimburse less than that the fee will be at least $100.01 across the board for that code. Quote Link to comment Share on other sites More sharing options...
UNDfaninMICH Posted March 7, 2014 Share Posted March 7, 2014 Question for the doctors: Why, when you have a hospital XRay or similar, do 5+ Dr's bill for reading it? Does it take that many, do all actually look at it, or is just an administrative automatic billing for every dr. that worked there that day? As far as I know, only one doc is going to get reimbursed for the specific billing code that applies to reading the diagnostic test. That is typically the radiologist. If I'm in the hospital seeing a patient and order for example, a chest x-ray, I might be able to look at it right after it is done, whereas there may not be a radiologist reading until after the point that the information is crucially important. My own reading of the chest x-ray gets wrapped into the billing I submit for the day (to put it simply, low, medium, or high complexity of service for that day). My own interpretation of the chest x-ray is just one of the potential components that might bump my level of care from medium or high complexity for that day. I don't bill directly for the chest x-ray, but I looked at it, I took action based upon it, and my actions (hopefully) benefited the patient. I think that's most of the rationale for why I can add that to my level of complexity, but there's also the fact that the ordering of and interpretation of a radiology study is another thing that increases the risk of harm to the patient and increases my risk of exposure to malpractice claims. Consultants like surgeons may be asked to also see the patient and they will also want to look at the radiology studies that have been done, but just like me, they aren't billing directly for viewing those studies. Yes, you want the oversight of the radiologist reading the test. But you also want the docs that have all of the clinical data about you and are seeing you in person to be seeing those x-rays for themselves. A common thing I deal with is radiologist reading of "pneumonia". Now I look at the x-ray, take into account the pattern on the x-ray along with the patient's history related to their illness, their exam, and perhaps some labs, and I figure whether it's most likely to be viral, bacterial, or fungal pneumonia. 1 Quote Link to comment Share on other sites More sharing options...
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