Over-Prescribing, Under-Prescribing, And The Fee-For-Service Catch 22

The federal government has granted itself potent new authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways, following through on a proposal issued earlier this year.

Excellent news! Now fee-for-service doctors can exist like Heller-esque protgaonists, trapped by the possibility of losing funding for over-prescribing, or losing funding by under-prescribing.

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The Medical Establishment Took The Treasury’s Keys

According to Uwe E. Reinhardt, an economics professor at Princeton, about half a century ago, organized medicine and the hospital industry in this country struck a deal with Congress.

In retrospect, it was as audacious as it was incredible: Congress was asked to surrender to these industries the keys to the United States Treasury.

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Yep, You Can Yelp Us

Some of the country’s best doctors have the worst patient satisfaction scores.

Want to know why?

Part of training to become a fee-for-service doctor is learning how to suppress your feelings. You get good at being who people want you to be, not who they need you to be.

You’re slowly transformed into something you didn’t foresee–a Stepford doctor out to please everyone with a sycophantic grin and forcibly appealing demeanor, hoping that your patient satisfaction survey will be favorable, no matter the cost.

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Red Tape By Any Other Name — How Medicare Drives High Healthcare Costs

Yes, Medicare pays the medical bills for millions of people 65 and older. And its benefit is tremendous. But recent studies show it plays another huge role in American healthcare: It helps set prices for everyone in the economy.

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Big News — The Real Winner In Healthcare’s Red Tape Might Be The Drug Companies

Looks like the Medicare program is the source of a small fortune for many U.S. doctors. So says a trove of government records that reveal unprecedented details about physician billing practices nationwide.

According to the new data, the government insurance program for older people paid nearly 4,000 physicians in excess of $1 million each in 2012. And those figures do not include what the doctors billed private insurance firms.

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Red Tape Wraps Up A Preventative Healthcare Clinic

Red Tape Wraps Up A Preventative Healthcare Clinic

MDPrevent closed on Dec. 27 2013. The preventive-medical practice was co-founded in Delray Beach, Florida three years ago. It’s premise was that patients would be better off if doctors focused on preventing disease instead of simply treating it. They ran into problems, though, and one of them was red tape. They claim that ultimately the three major healthcare industry players — providers, payers, and patients—all shared some responsibility for their failure, though.

Their experience with bureaucracy was costly. For every dollar they collected, their expenses were three times as much! Their vision was altruistic, and they’d assembled a team that included a health psychologist, registered dietitian, exercise physiologist, yoga instructor, health educator, and nurse practitioners. They designed a custom facility that included a teaching kitchen, a gym, and classrooms.

What turned out to be a huge mistake though was basing their business plan on insurance reimbursement rather than cash-only payments. They lost serious money, around $2 million in personal capital. When they saw how expensive operating was, they started cutting costs, trimming staff down to a health psychologist, a registered dietitian, and the founding doctor, who writes, “Medicare reimbursement we received for our services still could not cover our costs. I even abandoned the offices we had built-out and moved to less expensive quarters we shared with an internist. It still made no difference.” He adds, “Most of the third-party insurance companies in the area did not cover our services. Medicare was the exception, but reimbursement was insufficient to cover our costs.”

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A Tragicomic Irony: Pretending To Be Uninsured Might Save Patients Money

Dark Daily, our favorite watchdog publication, posted price comparisons between insured and uninsured patients. The numbers vary state to state, but the overall trend is that insured/Medicare patients are on average being charged a third of what uninsured patients are. This is a polar shift from the 1950s, when the poor and uninsured were charged the LOWEST rates of any patient. But there was also an ironic finding, steep cash discounts are being offered to patients who can pay for a service upfront. “[It was] suggested that when hospitals offer such deep discounts for paying cash, patients with high deductibles may be better off withholding their insurance information and paying the cash price.” This reminds us of a great quote by Richard Feynman, who says, “The thing that doesn’t fit is the thing that’s most interesting.”

More Reading
Hospitals Generally Charge Self-pay Patients Top Price for Care, but Some Providers Now Offer Deep Discounts for Patients Who Pay with Cash” | Dark Daily 

Direct Care IS The Rare Bipartisan Idea

Direct Care IS The Rare Bipartisan Idea

We came across an article called “The Rare Bipartisan Health Idea: Affordable Concierge Medicine” over on New Atlantic Ventures (navfund.com), a website promoting entrepreneurial endeavors. It makes sense that our Atlas MD style of direct care would be featured there, being as we believe healthcare can administered more effectively when coupled with free-market principles. To us it makes sense to run a business where WE are responsible for our profits and losses, WE interact with our customers directly, and WE succeed by giving them top-notch service. It so happens that in our case, doing our job well means we ensure healthy patients, something we take great pride in.

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