Legality wasn't the only problem with TrueCar...
http://www.forbes.com/sites/joannmul...g-his-company/
Legality wasn't the only problem with TrueCar...
http://www.forbes.com/sites/joannmul...g-his-company/
"One day, we shall die. All the other days, we shall live."
How is it a conflict of interest to own your own medical practice?Originally Posted by GGT
Also, bypassing insurance and Medicare is a small-but-growing trend. Preferential treatment of some sort for upfront cash payment is a common thing.
It looks like they tried to work within the car dealer industry, which is one of the most insanely over-protected and quasi-corrupt industries in the US. The current legal structure is almost as anti-consumer as current healthcare laws.
Which healthcare laws?
Faith is Hope (see Loki's sig for details)
If hindsight is 20-20, why is it so often ignored?
No sympathy for dealerships. If I could change the way we did our schooling system worked I'd mandate a real world financing class in schools. And one of those classes will be about how dealerships operate and the kind of scum they are.
As I think about this. First, let me state this I ABSOLUTELY believe in universal healthcare, as not only a Moral prerogative that ALL Christians and people of conscience should push for, but that it is a great positive externality that it prevents temporarily taking people out of the work force and creating cycles of unproductivity (injured so can't work- can't afford surgery so stay injured) plus the other family/friend negative externalities it brings on.
Moving on, I think we do need to use the power of the free market on the health care market as well, make it required by the Government that each hospital post % of successful surgeries for each particular surgery, and the price of those surgeries, as well as must have a rating system per each surgery, and a comment box (turn it into e-bay, or amazon). Secondly the government should have a system where people are encouraged to choose the best price, for example the government has a set amount it will pay for a particular surgery, and if you go over then the difference you will have to pay to them (very slowly over many years with a small interest), and any money you save by going under that price point can be placed in an emergency fund they have for you in particular, in case stuff does hit the fan some day. They can have two allotments one allotment per surgery, and one per year allotment. However much you saved off your per year allotment will go into your emergency fund. We just need a system that directly rewards smart shopping, that doesn't encourage people to abuse the system, or not seek help because doing so will in some way make them lose money (as in you're not going to get physical money back to spend as you want, for saving money). Side Note: IE 10 works terribly with this forum, can't press enter to create a new line.
Last edited by Lebanese Dragon; 08-04-2013 at 05:21 PM.
Here's an article in the NYT telling the story on implants, which they claim are basically the same for the last decade-and-a-half, but for minor tweaks while still being sold at prices a lot higher than 15 years ago. An example is given of a man whose hip implant in Belgium set him back $13k (including even his flights there and back) as compared to the $82K he got as an estimate for the same procedure in the US. As it happens the wholesale price of his implant in the US would have been a mere $660 less than the whole procedure in Belgium cost him. Supposedly producing the implant is in the $300 range.
article
Congratulations America
New joint replacements are not just tweaks on old technologies.
I think the real indictment is the cost of the hospital stay and middlemen, not the cost of the implant.
Total cost is obviously the important price, not just the price of the surgery. Needs to be total price (surgery, and average cost people spend to stay the night.). I understands people's concern about price wars at the expense of quality of care; however, people just like they do with anything else will take that into consideration. They'll decide whether to buy "80-20 ground beef" or 93-7, it's up to them, and the rating system I suggested will help let you know which is which.
Last edited by Lebanese Dragon; 08-05-2013 at 01:25 AM.
Ya know, the laws that give tax benefits to employer-based healthcare or the laws that prohibit health insurers from operating on a national level.
Speaking of which...
http://www.reuters.com/article/2013/...0G317S20130802
Aetna exits Obamacare exchange in Maryland over price
Fri Aug 2, 2013 3:48pm EDT
By Caroline Humer
Aug 2 (Reuters) - Aetna Inc pulled out of Maryland's health insurance exchange being created under President Barack Obama's healthcare reform law after the state pressed it to lower its proposed rates by up to 29 percent.Spoiler:
I was just coming here to post that. Though, like Wiggin, I think the article underplays the amount of development and tweaking that goes into these devices. But the real crime is the basic services are being insanely priced in a highly anti-consumer way.
This paragraph from the article about joint replacement says it all-
It's a market begging for reform.In addition, device makers typically require doctors’ groups and hospitals to sign nondisclosure agreements about prices, which means institutions do not know what their competitors are paying. This secrecy erodes bargaining power and has allowed a small industry of profit-taking middlemen to flourish: joint implant purchasing consultants, implant billing companies, joint brokers. There are as many as 13 layers of vendors between the physician and the patient for a hip replacement, according to Kate Willhite, a former executive director of the Manitowoc Surgery Center in Wisconsin.
What I didn't get is that the article seemed moderately well researched - they highlighted many of the absurdities in how the pricing system works. But they then focused on the element of the cost which is not the major driver of the difference between a foreign surgery and a domestic one, and made some pretty unfounded statements about the technology as well. I guess they just wanted to be able to blame Zimmer et al? (I also love how they ignore the very reasonable critique of the PPACA excise tax on medical devices without much discussion.)
I can speak from personal experience (I have worked in orthopedic biomaterials for the last 7 years) - joint replacement technology has advanced by leaps and bounds from the relatively primitive implants used in the past. Most of it is necessity - in the absence of good therapies for osteoarthritis and cartilage defects, surgeons desperately need implants that will work in younger and younger patients. Old school hip/knee total joint replacements work for a healthy 75 year old, since you figure that (1) their activity level is lower, so the number of load cycles (and likely their intensity) will be lower, and (2) they aren't likely to outlive the implant (also 3: they have healthy enough bone turnover - e.g. no osteoporosis - that they'll get good implant integration). But doing the same to a 50 year old is a recipe for disaster - requiring multiple revision surgeries at shorter and shorter times in a vicious cycle. So the joint replacement companies have had to do some pretty fancy innovation in materials design to improve the longevity of their implants.
The underlying technologies are quite sophisticated. For example, a lot of effort has gone into reducing wear and wear particles - lots of people have played with material design and manufacturing techniques to make a bearing surface for hip implants that will last much longer than older technologies, which much fewer wear particles to affect the implants and the biology (I actually just reviewed a promotion application for one of those evil academic/clinical scientists who's taking money from these companies and helping improve people's lives). Implant loosening is also a significant issue, especially because of potential long-term issues with tissue/material interactions at the surface and poor osseointegration. There's intensive research into different coating technologies that will enhance implant integration with the surrounding bone (though personally I'm less convinced that much of the work done here has really solved this problem yet).
The point is that there is a lot of new technology coming on board on a relatively frequent basis, and while it's probably irrelevant for a run-of-the-mill elderly patient, it's absolutely critical for the faster growing age groups (mostly 40s and 50s). Some innovations work better than others, true, and that's why we have clinical research - to catch ineffective treatments as they get rolled out on a larger scale and for a longer time than is possible for clinical trials. The orthopedics companies haven't been sitting on their asses, twiddling their thumbs, and watching the big bucks roll in.
I have no doubt there's plenty of room for savings - for one, having older functional designs be used for uncomplicated cases, for another fixing the byzantine procurement system. There have also been issues - as with most device/pharma companies - with sales reps getting a bit too chummy with physicians. The largest driver of overall costs, though, has little to do with the actual device pricing and far more to do with our dysfunctional hospitals and billing/insurance systems.
A private, for-profit, surgical clinic owned by the surgeons is different than other medical practices. Surgeons can tend toward surgery as the best patient option, since that's their area of expertise. Like the hammer that sees everything as a nail.How is it a conflict of interest to own your own medical practice?
Particularly if they bypass traditional insurance or Medicare --- that would require a second opinion from another surgeon (without a profit interest) --- and help determine "medical necessity".Also, bypassing insurance and Medicare is a small-but-growing trend. Preferential treatment of some sort for upfront cash payment is a common thing.
Sure, it's a growing trend to pay cash upfront and eliminate the insurance middleman for medical care. We've talked about that for years.I'm skeptical of that model working for elective surgeries, though. It sounds ripe for abuse.
Funny, GGT, in many fields (especially in Europe) it's illegal for non-practitioners to own a professional services practice (e.g. lawyers must own a law firm, nor corporations, etc.). I don't disagree there's an incentive for them to maximize profits then, but that can work both ways - by charging more, but also by cutting costs. I don't see an inherent issue any more than other systems. In fact, the majority of non-hospitalist physicians in the country probably own their own practices.
I don't mind if the pricing on a procedure is profit driven, but I do mind if the recommendation for the procedure is. Capitalism works great when all the cards are on the table for buyer and seller, but when the seller (in this case the doctor can lie to you or mislead you, in much the same way any expert in a field can, say a auto-repair shop, then we have a moral hazard issue.) The government needs to regulate it somehow.
Medicine isn't like 'other systems' or professional services, though. It's not an 'industry' that should be based on consumption as profits. Particularly surgical practices, where the risk is surgeons over-prescribing their own services, and/or using surgery as first choice instead of other treatments. Legal services is an interesting analogy -- it makes sense that a group of police shouldn't own a LLC law firm, because they could profit by making arrests. (Not to muddy the conversation more, but that's also a good reason to oppose privately owned prisons.)
The NYT article mentioned medical implants, and teaching surgeons procedures based around brand types, which grooms a loyalty by familiarity. Might be good to hone surgical skills, but not necessarily good for the patient....who may not get all the options and choices available, let alone the best medical advice.
We've seen that kind of thing happen in cosmetic surgery, where teenaged girls can get breast implants and fragile 80 year olds have face lifts under general anesthesia (both against AMA recommendations).
It's the NYTimes. They are conditioned to never associate taxes with cost/price increases.
What the...
Okay. Fine. I'll bite. Who do you think should own surgical and medical practices? Giant multinational corporations? Hedge funds?
I don't believe GGT's argument was about ownership. It's about accountability.
Faith is Hope (see Loki's sig for details)
If hindsight is 20-20, why is it so often ignored?
Obviously the government... you haven't been paying attention to GGT the last few years.
No, GGT was pretty clear it was an ownership issue.
Actually, it's the interplay between physician ownership and accountability, and how that affects the patient.
Outpatient surgical sites aren't 'hospitals'. Publishing rates isn't 'capitalism ensuing'. Let's get that straight.
Literally millions of patients are still responsible for 20% of their medical/surgical bills, even with good insurance plans (including Medicare), whether at hospitals or outpatient surgery clinics. That's on top of monthly premiums, often paid for years. No wonder folks are looking outside the US for "affordable" surgeries, or choosing owner/operator surgeons that bypass insurance, even when evaluations for medical necessity are part of patient protections in their insurance policies.
Medical costs are the #1 cause for personal bankruptcy in the US, but that's a pretty shitty incentive. Most people don't have ten thousand dollars (or more) to plop down for the care they need, even when that means a substantial savings. Nor should they. The entire US system of "healthcare" is dysfunctional.
You haven't answered the question. If doctors and surgeons shouldn't own medical practices, what ownership structure do you propose? Maybe we can connect you with a hedge fund who can run them instead.
Simple: conflict-of-interest. Kick-back profits. You probably don't remember the scandals in radiology years ago, when the technology of MRIs and CAT scans left hospitals, and outpatient sites began to pop up. Many turned out to be owned by physician LLCs, who would send patients to their own facilities, often over-ordering or duplicating scans. Similar to pharmaceutical companies sending doctors to exotic places for "medical conferences", drug reps buying lunches and giving gifts, in exchange for their brand of drugs being prescribed. It took legislation to crack down on that type of "business"....because it's a crappy way to practice medicine.
If surgeons own and operate their own surgical clinics -- performing surgeries they recommend -- there should be some kind of process to protect the patient. Whether it's an outside second opinion or referral, or a review board with physicians that don't have a financial interest, something along those lines.
Do you object to patient protections, especially when surgery is concerned?
Ummmm...how did the patient wind up at the surgical clinic? You don't just walk into a place like that an ask for a recommendation. You get referred by another doctor, normally your primary, because you have something that needs to be treated. And if its a surgical practice, I would hope that you are there because your primary thinks surgery is needed.
While I'm sure there may be some surgeons out there that will push for surgery, but in today's age of litigation, you really think there is an epidemic of needless surgeries taking place?
Oh, and you still haven't really answered Dread's question. Not that I expect you to.
Brevior saltare cum deformibus viris est vita
I answered Dread, even though he conflated my comment. Where did I say surgeons should never own a surgical clinic?
What I said is it'd be a good idea to have some patient protections in place at outpatient facilities. We have one here specializing in orthopedic and spinal surgeries. They accept walk-ins and emergencies (folks with bulging discs, sciatica, etc.), and will do same-day surgeries...for patients who bypass insurance review, and pay cash.
I wouldn't say epidemic but . . .
http://www.usatoday.com/story/news/h...dical/2439075/
Get off my lawn
I can live without #16 and #17
Exactly. Not only that, but those spinal surgeries often lead to other medical problems. Limited mobility, urinary incontinence, chronic pain."Since the 1980s, operations for low-back pain have increased from about 190,000 to more than 300,000 per year," Consumer Reports noted in 2005. "Many of those operations are probably unnecessary."Those patients often end up needing more medical care....at Hospitals.
In fairness, there are probably quite a few practitioners in Plastics in their clinic and many (most?) elective surgeries don't go through primary-care first.
Last night as I lay in bed, looking up at the stars, I thought, “Where the hell is my ceiling?"
Well, that's elective, in theory you were looking to have the surgery.
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You said it was a conflict of interest, and even wiggin took you to task on that. What else would we interpret from that?I answered Dread, even though he conflated my comment. Where did I say surgeons should never own a surgical clinic?
What I said is it'd be a good idea to have some patient protections in place at outpatient facilities. We have one here specializing in orthopedic and spinal surgeries. They accept walk-ins and emergencies (folks with bulging discs, sciatica, etc.), and will do same-day surgeries...for patients who bypass insurance review, and pay cash.
So it's okay by you as long as we have 'protections' in place?
Brevior saltare cum deformibus viris est vita
If you have a better proposals to protect patients, post them.
Jesus, can you answer the question? I'm not the one seeing an issue with owners of practices being the practitioners.
Also wrt back surgeries, in my small experience, surgery was the last resort unless it was painfully obvious that it was the only way to correct, just because of those issues you mentioned earlier. So, I'll take the USA Today with some salt.
Brevior saltare cum deformibus viris est vita
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