Posted in Access to healthcare, Affordable Care Act (ObamaCare), Crony Capitalism, DC & Related Shenanigans, Economic Issues, Electronic Health Records, Free-Market, Government Spending, Health Insurance, Hospital Uncompensated Care / Disproportionate Share Revenue, Independent Physicians, Influence peddling, Medical Costs, Organizational structure, Patient Choice, Patient Safety, Policy Issues, Price Tansparency, Quality

G. Keith Smith, M.D. – 10 Health Care Myths, and the Truth – 10 Health Care Myths, and the Truth

Dr. Keith Smith
Dr. Keith Smith

7). Free market principles don’t apply to health care.

Free market principles always apply, in spite of all attempts by the state to thwart them.  Acting in concert and consistent with free market principles allows for the most rational and fair and least wasteful and most moral allocation of resources.  Acting in concert with the free market and its characteristic open competition causes quality to soar and prices to plummet.  Every time, no exceptions.  Patients from all over the country are using our online pricing to leverage better deals in their local medical markets, as our facility and others embracing transparent pricing are only a short plane ride away!  As hard as many hospitals are trying to avoid it, they are in a competitive marketplace whether they like it or not.  Those in the medical industrial complex who say that free market principles don’t apply to their industry are typically those who benefit from avoiding competition at all costs.

Read the full article at: G. Keith Smith, M.D. – 10 Health Care Myths, and the Truth – 10 Health Care Myths, and the Truth.

Posted in Access to healthcare, Accountable Care Organizations, Economic Issues, Employer-Sponsored Health Plans, Federal Exchanges, Government Regulations, Health Insurance, Hospital Uncompensated Care / Disproportionate Share Revenue, Individual Mandate, Insurance subsidies, Medicaid, Medical Costs, Policy Issues, Rule of Law, State-Run Insurance Exchanges, Subsidies, U.S. Constitution, Uncategorized, Uninsured

King v. Burwell: How Important Is Obamacare’s Individual Mandate? | Health Policy Blog | NCPA.org

President Obama recently stated that, “Congress could fix this whole thing with a one-sentence provision.” True: Repealing Obamacare in its entirety would only take one sentence. However, that is not likely what he meant. Congress would have the opportunity to propose changes to Obamacare, but they would have to be signed by a reluctant president who will never again face the voters.

Now that both chambers of Congress have Republican majorities, any legislative response will surely include eliminating the individual mandate, the most unpopular feature of the law. Victory for King would make Obamacare policies in most of the country “unaffordable” and thereby relieve 11.1 million people of the individual mandate. Any “fix” that re-imposes the mandate would be political kryptonite for this Congress.

However, the most popular provision of the law is the prohibition against health insurers taking pre-existing conditions into account when setting premiums or scheduling benefits. Obamacare’s supporters insist the two features go hand in glove. Because the law forces health insurers to accept any applicants without taking pre-existing conditions into consideration and charge everyone (except tobacco users) the same age the same premium, it must be coupled with an individual mandate.

If not coupled with a penalty (or fine or tax) for not having health insurance, people would simply wait until they get sick or injured and then buy health insurance. This leads to a so-called death spiral as health insurers increase their premiums in response to individuals’ behavior. It is an impeccable theory, but it does not hold up in a system run by politicians.

via King v. Burwell: How Important Is Obamacare’s Individual Mandate? | Health Policy Blog | NCPA.org.

Posted in Access to healthcare, Economic Issues, Health Insurance, Hospital Uncompensated Care / Disproportionate Share Revenue, Medical Costs, Medical Practice Models, Patient Choice, Patient Safety, Policy Issues, Third-Party Free Practices, Uncategorized

Perverse Incentives Promote Higher Costs | Robert Nelson, MD | LinkedIn

images (22)I recently had a conversation with a local neurologist who I wished to utilize as a referral physician for my patients. He is employed by a large well-respected healthcare system. By all measures, the employed doctors and the organization are top-notch in the industry and represent all the major specialties. He was detailing some of the services that they could provide to outpatients in their clinic when I asked whether he performed diagnostic or therapeutic lumbar punctures on non-emergent stable patients. He informed me that the average reimbursement for him to do an LP in the office was about $40 and that he could see two patients in the time it took him to do one LP, which reimburse about 3x the fee compared to the LP. So $40 vs. $240 for an hour of work: That’s a no-brainer.

So how do their patients get the lumbar puncture if they need it? They are referred to the Radiology group of the same employer where the procedure is done under ultrasound guidance (cheater scope) which is billed at $1500. Before you say that ultrasound guided LP’s are so much safer, etc… The use of ultrasound technology and the marginal increase in safety in low risk patients and does not justify the difference in cost. Most all neurologists and neurosurgeons will confirm this.

Read entire article via Perverse Incentives Promote Higher Costs | Robert Nelson, MD | LinkedIn.

Posted in Affordable Care Act (ObamaCare), Deductibles, Direct-Pay Medicine, Economic Issues, Electronic Health Records, Employer-Sponsored Health Plans, Entrepreneurs, Free-Market, Government Regulations, Health Insurance, Hospital Uncompensated Care / Disproportionate Share Revenue, Independent Physicians, Influence peddling, Medical Costs, Medical Practice Models, Medicare, Organizational structure, Patient Choice, Patient Safety, Policy Issues, Price Tansparency, Quality, Re-Pricing Scams, Self-Insured Plans, Uncategorized

How the Market Can Cure the Health Care Crisis w/Dr. Keith Smith! – YouTube

via How the Market Can Cure the Health Care Crisis w/Dr. Keith Smith! – YouTube.

Posted in Bailouts, Capers, Crony Capitalism, Economic Issues, Government Regulations, Government Spending, Health Insurance, Hospital Uncompensated Care / Disproportionate Share Revenue, Influence peddling, Medical Costs, Poverty, Price Tansparency, Re-Pricing Scams, Uncategorized, Unemployment, Uninsured

Hospitals Profit From Drug Discount Program For Poor Americans – Forbes

A new study by Drs. Rena M. Conti and Peter B. Bach makes a valuable contribution to the growing body of evidence on the harm being done by a federal program that Congress designed to increase poor people’s access to prescription drugs, but has been perverted by hospitals to pad their bottom line.

The 340B program was legislated in 1992. It gives the federal government the power to force drug-makers to offer deep discounts on medicines dispensed to outpatients. 340B was supposed to be a win for both poor people and taxpayers: By forcing drug-makers to discount prices, it would reduce poor people’s costs, and therefore the demand for federal subsidies to safety-net facilities in those areas.

The number of hospitals and other facilities taking advantage of 340B had doubled in ten years. Conti and Bach explain how, where, and why this is happening. The key is that, although hospitals get the discounts, there is no effective way to ensure that the discounts are passed on to poor people. Once the discounted drugs are inside the hospital system, they are just added to the inventory.

Conti and Bach review disturbing cases:

via Hospitals Profit From Drug Discount Program For Poor Americans – Forbes.

Posted in British National Health Service, Canadian Health System, Consumption Inequality, Economic Issues, Government Regulations, Hospital Uncompensated Care / Disproportionate Share Revenue, Medical Costs, Medicare, Policy Issues, Price Tansparency, Protocols, Tax Policy, Uncategorized

Medicine’s Top Earners Are Not the M.D.s – NYTimes.com

THOUGH the recent release of Medicare’s physician payments cast a spotlight on the millions of dollars paid to some specialists, there is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack.

That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.

The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.

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And studies suggest that administrative costs make up 20 to 30 percent of the United States health care bill, far higher than in any other country. American insurers, meanwhile, spent $606 per person on administrative costs, more than twice as much as in any other developed country and more than three times as much as many, according to a study by the Commonwealth Fund.

As a result of the system’s complexity, there are many jobs descriptions for positions that often don’t exist elsewhere: medical coders, claims adjusters, medical device brokers, drug purchasers — not to mention the “navigators” created by the Affordable Care Act.

Among doctors, there is growing frustration over the army of businesspeople around them and the impact of administrative costs, which are reflected in inflated charges for medical services.

via Medicine’s Top Earners Are Not the M.D.s – NYTimes.com.

Posted in Deductibles, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Employee Benefits, Health Insurance, Hospital Uncompensated Care / Disproportionate Share Revenue, Independent Physicians, Influence peddling, Patient Choice, Price Tansparency, Third-Party Free Practices, Uncategorized

Disruption of the Healthcare Syndicate – By: G. Keith Smith, M.D. – http://SurgeryCenterOK.com

Disruption of the Healthcare Syndicate
G. Keith Smith, MD

“…This coercive, anticompetitive system has survived to this day, under government protection, resulting in the runaway costs and obscene corporate profits you would expect. This syndicate generates gigantic hospital bills, and the extent to which these bills remain uncollected provides the basis for the taxpayer subsidization known as the uncompensated care system, or disproportionate share hospital (DSH) payments.

The hospital charges $100 for an aspirin, collects $5, and claims to have “lost” $95. Such false losses maintain the fiction of the hospitals’ “not for profit” status. Often, insurance companies sell their “discounting” services. For example, they may reduce a bill from $100,000 to $20,000 and collect a percentage of the false “savings.” This is the “repricing” scam. This setup perversely inclines the insurance carriers to seek out the highest bills they can find, assiduously avoiding better priced alternatives.

Nothing could be more disruptive to this syndicate than a fresh dose of the principles of the free market, more specifically, upfront and transparent pricing. Not only does reference pricing expose the health care racket, but simultaneously provides a powerful deflationary influence, as fear of the loss of patients to a better-priced facility retains great power even in this corporatist soup.”

via Disruption of the Healthcare Syndicate.