Originally Posted by Storythree
I am a doctor and this post bothers me. Makes me feel like eventually I'm just going to be another government resource to be rationed and given out at the discretion of a bureaucracy.
If someone wants to see a doctor (demand) and I am willing to see them (Supply) then why can't we set a price (money: mutual benefit) for the service?
I hate to write this but... isn't that already happening? That's what the docs I work with every day are asserting; loudly. It's also what I observe from my perspective one step removed from them.
They are cardiologists, cardiac surgeons, radiologists, vascular interventionists, vascular surgeons, intensivists and emergency medicine physicians along with our various different regional hospital directors who are within a few years of clinical practices throughout our system. I don't know what discipline you practice in and as you know, things are different among the service lines so your experience could be quite different.
I can only think of one of them that thinks this approach is a good for patients and applied health care. That's one of the directors (Medical Staff Office). We have had quite a few speakers come through from places like the Advisory Board that really extol the virtues of the changes but there's always subtext in these topics like, "The best choices are no longer the best choices, but the best choices available". Yikes.
We get weekly webinars from Medtronic, Boston Sci etc about how to figure out who can get an ICD vs who has to wear a vest and everyone still makes mistakes figuring that out. The sickening part is that we don't actually know if we're going to be reimbursed for the devices and procedures until AFTER it's billed because medicare can only give us, "Guidance" and not rulings on individual cases. That's a $50k+ case that is life and death to the patient. Then, if we go ahead and do them and submit for reimbursement and CMS sicks the Dept of Justice on us (just like my previously mentioned Cleveland Clinic example who was used as a MODEL for THEIR SYSTEM). At the end of that, what is a hospital (or any provider) going to do? Go after a fixed income medicare patient that cannot possibly pay that back? Of course not, it's written off as a loss.
That type of system has completely commoditized both the service and the supplies from my understanding of the concepts.