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chess9
11-26-2009, 02:53 PM
$456! Incredible. I cannot believe it....

-Robert

Puddy
11-26-2009, 03:02 PM
$456! Incredible. I cannot believe it....

-Robert

What did the MD shoot you with?

What kind of bandaid? A cool Superman version? I hear those can be a bit costly. :-?

BreakPoint
11-26-2009, 03:02 PM
$456! Incredible. I cannot believe it....

-Robert
That's why I never go to the doctor. :)

yemenmocha
11-26-2009, 04:38 PM
Are you kidding me?

Do you know how much it costs for a plumber or an electrician? This is a visit to doctor and that seems like too much?

I've spent nearly $5000 on my GE and it's still not better, including multiple doctor visits (including a 2nd opinion), an MRI, two cortisone shots, and many PT sessions.

Moz
11-26-2009, 04:56 PM
Are you kidding me?

Do you know how much it costs for a plumber or an electrician? This is a visit to doctor and that seems like too much?

I've spent nearly $5000 on my GE and it's still not better, including multiple doctor visits (including a 2nd opinion), an MRI, two cortisone shots, and many PT sessions.

I'm not clear here - your $5000 bill has not improved your condition but you don't think the doctor costs too much? Or are you just warning Robert of what is to come? :)

At least when you employ a plumber you can flush your toilet afterwards.

Hope it gets better for you mate - mine didn't. I started running again instead!

yemenmocha
11-26-2009, 05:12 PM
I'm not clear here - your $5000 bill has not improved your condition but you don't think the doctor costs too much? Or are you just warning Robert of what is to come? :)

At least when you employ a plumber you can flush your toilet afterwards.

Hope it gets better for you mate - mine didn't. I started running again instead!

Heck yeah I hope it gets better. It started 18 months ago. A few doctor visits with cortisone shots on different times, followed by no 3rd cortisone and instead referred me to doing ASTYM. Did that and PT for awhile with various treatments (around $80/visit, several times per week). MRI after that. After 6 months I tried to come back to tennis slowly and the GE returned. Went to an orthopedic guy who specializes in arms. No surgery recommended, instead take 1 full year off.

It all adds up. It was a sum, not one visit for $5000.

I was making a general point though that I'm surprised that people are so surprised at doctor's bills.

EcoRick
11-26-2009, 07:15 PM
$456! Incredible. I cannot believe it....

-Robert

I'm assuming you were also prescribed physical therapy. If it works, it will be well worth it. I had it a few years ago and can't imagine my life without the cortisone and therapy. After a few months, it was all cleared up.

chess9
11-27-2009, 03:39 AM
That is the bill for one visit with the doctor's P.A. and a shot. The whole thing took about 15 minutes.

The cost seems excessive.

-Robert

mikeler
11-27-2009, 07:01 AM
My visit to an orthopedic surgeon for GE was $25 but I have health insurance. I don't think the cortisone pills were very expensive either. I'm currently paying $40 a pop to visit a chiropractor that does not take my insurance. The electrostimulation and ultrasound therapy is really working for me.

equinox
11-27-2009, 07:32 AM
democratic way for the government to send a message.
If you can't afford to live, then don't do so. die painfully instead.

chess9
11-27-2009, 10:19 AM
My visit to an orthopedic surgeon for GE was $25 but I have health insurance. I don't think the cortisone pills were very expensive either. I'm currently paying $40 a pop to visit a chiropractor that does not take my insurance. The electrostimulation and ultrasound therapy is really working for me.

Oh, yes, I have insurance. That's what they billed my insurance company. No wonder insurance bills are so high! I only paid my co-pay of $25, but I paid for the Medicare Advantage plan through my medicare payments. I just think no one should be ripped off in this system, but I think the doctors need to show some restraint, and particularly the specialists.

This guy's getting over $1500 an hour.

-Robert

mikeler
11-27-2009, 10:50 AM
How well did the shot work for you? My pain also included triceps tendinitis so I had to take the pills. Within 2 days I had no pain. Then it gradually came back when I started playing again.

scotus
11-27-2009, 10:50 AM
Oh, yes, I have insurance. That's what they billed my insurance company. No wonder insurance bills are so high! I only paid my co-pay of $25, but I paid for the Medicare Advantage plan through my medicare payments. I just think no one should be ripped off in this system, but I think the doctors need to show some restraint, and particularly the specialists.

This guy's getting over $1500 an hour.

-Robert

The cortisone shots are that expensive.

And most doctors don't make that much money. It's pittance compared to blood-sucking lawyers (Okay, there are some lawyers who are sort of at "pro bono" work level).

But take this. My chiropractor bills my insurance company $250 for what amounts to 15 minutes of his time, 5 minutes of his assistant's time, and 30 minutes on his massage chair (a machine). Now this guy grosses $1000 an hour.

yemenmocha
11-27-2009, 11:17 AM
Oh, yes, I have insurance. That's what they billed my insurance company. No wonder insurance bills are so high! I only paid my co-pay of $25, but I paid for the Medicare Advantage plan through my medicare payments. I just think no one should be ripped off in this system, but I think the doctors need to show some restraint, and particularly the specialists.

This guy's getting over $1500 an hour.

-Robert

Your doctor is not "getting over $1500 an hour". Most of the costs are not the doctor's takehome salary - the facility, the equipment (including R&D that goes into equipment, meds, etc.), the nursing staff, the administrative staff, etc. and oh... let's not forget that you also pay for the people who try to sue for frivolous reasons. Sorry, but it strikes me as either naive or downright belligerent to think/say that the doctor is getting $1500 an hour.

yemenmocha
11-27-2009, 11:18 AM
The cortisone shots are that expensive.

And most doctors don't make that much money. It's pittance compared to blood-sucking lawyers (Okay, there are some lawyers who are sort of at "pro bono" work level).

But take this. My chiropractor bills my insurance company $250 for what amounts to 15 minutes of his time, 5 minutes of his assistant's time, and 30 minutes on his massage chair (a machine). Now this guy grosses $1000 an hour.

Finally, some sense in this thread. I'm not going to run with the lawyer rant but you're right, most of the costs of the bill are NOT going to the doctor's salary.

chess9
11-27-2009, 11:37 AM
I didn't say it was going to his salary, but I ran my own law office, and we tried to keep expenses around 55% of income. I don't know anything about medical office economics, but even if his overhead is 60%, he's taking home a bundle. Maybe I'm wrong. I admit I don't know enough about medical office costs.

How expensive can cortisone be? $20 for the doctor?

-Robert

TheMagicianOfPrecision
11-27-2009, 12:14 PM
$456! Incredible. I cannot believe it....

-Robert

I broke my leg 4 years ago, stayed 2 nights at the hospital- The bill was 25 USD :)

chess9
11-27-2009, 12:16 PM
But, aren't you a 3.5? ;)

-Robert

mike53
11-27-2009, 01:08 PM
Oh, yes, I have insurance. That's what they billed my insurance company.


Just because they bill that amount doesn't mean they get it. Your doc would be lucky to get $100 from the insurance company, but he gets to keep your entire copay. If he runs enough people through at $25/shot, he can make a decent living.

chess9
11-27-2009, 01:25 PM
Just because they bill that amount doesn't mean they get it. Your doc would be lucky to get $100 from the insurance company, but he gets to keep your entire copay. If he runs enough people through at $25/shot, he can make a decent living.

No, that's what my insurance company says they paid him. My carrier is United Healthcare and they send me monthly statements. Since the insurance carriers have been taking so much heat, I think they want the patients to know what the doctors are charging. United won't be my carrier January 1, however.

-Robert

mike53
11-27-2009, 01:43 PM
So United paid the doctor what he billed them or did he bill them something like $1200?

charliefedererer
11-27-2009, 03:54 PM
It sounds like you haven't figured out the way medical billing works .

It's a lot like the old Soviet system: They pretended to pay the workers and the workers pretended to work.

That doc is not going to see more than $150.
It doesn't matter what he charges, it's what he collects.
But if sets his rates lower, the insurance company will pay him even less.
No it does not make sense.
But it is the insurance company that sets the rules. And the billing company for the doctor submits rates it has established for working with many other specialists. The doctor rarely has has more than a vague idea about what his actual charges are. He just knows he's only going to see a fraction from the insurance company.

larry10s
11-27-2009, 04:06 PM
$456! Incredible. I cannot believe it....

-Robert

i have not read all the posts but my question is what did your insurance pay?? i assume your doctor accepted your insurance so that is what he was paid and you did noy pay the difference??? yes???

mlktennis
11-28-2009, 07:12 AM
The doc has gone through 4yrs college, 4 yrs med school, prob 5 yrs orthopedic residency and didn't prob make any real money till 35+ yrs old.

Med school education prob 200K not including undergraduate college.

pays prob 100K in malpractice,

is at the mercy of whatever insurance wants to pay him.

Works prob 80-100hrs a week

every tom,dick or jane wants to sue him whenever anything doesn't turn out like it should, or just b/c he wasn't nice.

What do you think his services to diagnose and treat your body are worth?

charliefedererer
11-28-2009, 07:21 AM
i have not read all the posts but my question is what did your insurance pay?? i assume your doctor accepted your insurance so that is what he was paid and you did noy pay the difference??? yes???

In most areas the doctor only collects what the insurance company pays. As part of the standard agreements he signs with the insurers, Medicaire and Medicaid, there is a clause that the physician will accept the payment from the insurer and not bill the patient the remainder of the bill.
Independent physicians, and small to medium size hospitals don't really have bargaining power to change the rates. They can take it or leave it with each insurer. But it's usually take it as the big insurers cover the majority of people, and hence their potential patients.
It's all an example of the "golden rule". He who owns the gold rules. The insurance companies, Medicaire and Medicaid hold the gold. They set the rules.

mlktennis
11-28-2009, 07:43 AM
Most rates in most professions go up as inflation goes and as the markets will bear. This is fair, but did you know that most doctors are getting making the same or less money for the last 8-10 years and having to work harder and harder for the same coin year after year? This while malpractice rates go through the roof.

Put all this together and what you are and will be seeing is that the best and brightest minds will not be stupid enough to go into medicine...and when they do, the financial pressures will be so great that they will lose sight of what brought them into the profession in the first place.

charliefedererer
11-28-2009, 08:03 AM
Most rates in most professions go up as inflation goes and as the markets will bear. This is fair, but did you know that most doctors are getting making the same or less money for the last 8-10 years and having to work harder and harder for the same coin year after year? This while malpractice rates go through the roof.

Put all this together and what you are and will be seeing is that the best and brightest minds will not be stupid enough to go into medicine...and when they do, the financial pressures will be so great that they will lose sight of what brought them into the profession in the first place.

A long time ago medicine was a "mom and pop" enterprise. Doctor's set their rates, and patient's paid for service out of pocket, if they were able.
Now of course everything is on a data base, and the same crushing push for increased productivity is applied to medicine as it is to any business. No doctor is happy with this. I don't think insurance companies are happy either. It's just the way it is. And with taxpayers facing an ever bigger portion of medical bills, the push for greater productivity is of course only going to intensify. Of course greater productivity has to mean less personal care. But that is definitely going to be the trend.

chess9
11-28-2009, 08:30 AM
So United paid the doctor what he billed them or did he bill them something like $1200?

Good grief! I have no clue if he billed more. LOL! The copy I got just showed what they paid him.

-Robert

chess9
11-28-2009, 08:36 AM
The doc has gone through 4yrs college, 4 yrs med school, prob 5 yrs orthopedic residency and didn't prob make any real money till 35+ yrs old.

Med school education prob 200K not including undergraduate college.

pays prob 100K in malpractice,

is at the mercy of whatever insurance wants to pay him.

Works prob 80-100hrs a week

every tom,dick or jane wants to sue him whenever anything doesn't turn out like it should, or just b/c he wasn't nice.

What do you think his services to diagnose and treat your body are worth?

I didn't even see the ortho doctor. I saw his PA. I think $250 an hour seems reasonable for a doctor. That's $10,000 a week on 40 hours. :)

-Robert

charliefedererer
11-28-2009, 10:02 AM
No, that's what my insurance company says they paid him. My carrier is United Healthcare and they send me monthly statements. Since the insurance carriers have been taking so much heat, I think they want the patients to know what the doctors are charging. United won't be my carrier January 1, however.

-Robert

Bob,

I, and three other surgeons tried to form a group about twenty years ago.

We paid an attorney $25,000 to draw up the agreement.

But we never finished, because it was clear this was just an initial payment, and the final agreement was going to cost a lot more.

I just wanted to let people know what attorneys charge.

charliefedererer
11-28-2009, 10:25 AM
It seem like the cost of injections varyhttp://www.steadyhealth.com/How_much_do_cortisone_injections_cost__t135946.htm l based on the responses on this web site:

I just had an elbow injection in kansas city by my md...the cost with office visit was $249 less 20% because I paid in full at time of treatment

I went to the ortho dr and he told me off the cuff the shot is cheap about 40 bucks and when I got the desk to pay it was 300.00 I freaked I dont have Dr office visits covered or shots pretty much cheap coverage, but I told her hey wait, the dr told me 40.00 so she looked again and said, Oh Ok 260.00, I told her look thats still too much, mind you I have never had to do this before I have had great coverage for 53 years but with my job loss I didnt have but cheap 200.00 a month coverage, she checked with the Dr he says is what it is and said to her give her the cash price less 25% so thankful.. I am getting some other shot that lubed your knee joint it costs 600-800 but the cash price would be 505.00 she told me costing me heaps.. gotta do it.. I have bone on bone on my right knee. I used to be a meat cutter for 24 years this heavy lifting was not good for my knees.. hope this helps.

Just had a cortisone injection in my elbow that was performed by my family doctor and it cost $250. A friend just had the uterus cut out of his cat and with anesthesia and pain meds, he paid $90. Doesn't that seem fair?

yemenmocha
11-28-2009, 10:28 AM
Bob,

I, and three other surgeons tried to form a group about twenty years ago.

We paid an attorney $25,000 to draw up the agreement.

But we never finished, because it was clear this was just an initial payment, and the final agreement was going to cost a lot more.

I just wanted to let people know what attorneys charge.

Wow, just amazing what attorneys charge. And law school is only 3 years, with no internship & residency, and it's incredibly easy to get into law schools outside the 1st tier. Simple robbery for them to charge you that much.

An agreement from an attorney should cost.... ah.... uhhh... no more than $750. You overpaid. :shock:

chess9
11-28-2009, 10:49 AM
Wow, just amazing what attorneys charge. And law school is only 3 years, with no internship & residency, and it's incredibly easy to get into law schools outside the 1st tier. Simple robbery for them to charge you that much.

An agreement from an attorney should cost.... ah.... uhhh... no more than $750. You overpaid. :shock:

Do you have any idea how hard it can be to get 4 doctors to agree on the color of carpet, let alone all the legal nuts and bolts? I hesitate to offer an opinion because the amount of time and expertise involved could be anywhere from 2 hours to 50 hours, with tax lawyers, corporate lawyers, an insurance guy for malpractice/building/premises, leasing agent, realtor, etc. If the agreement can be drawn up for $750 then you can get a form off the internet and edit it for your needs. You don't need someone with a brain. ;)

I can honestly say I never netted over $200K in my years in practice. I was probably in the middle in terms of income as I spent some time being politically active and some being a jock. ;) A lot of young lawyers were making $50K a year, and in today's climate, I'll bet a lot are unemployed. No doctors are unemployed unless they were bad or have retired. It's a recession proof industry! They almost have to kill people in groups of 100 or more to lose their licenses. ;) j/k

-Robert

mikeler
11-28-2009, 11:44 AM
My Dad is a general MD. He makes about 5 times less now than he made 20 years ago.

yemenmocha
11-28-2009, 01:17 PM
Chess9 - I was being sarcastic. :-)

Mikeler - that's the sad reality. A procedure that the market would bear at $2500 in 1983 is lucky to be reimbursed at $1000 now because of non-negotiable Medicare and other factors. Nobody realizes that while most professional careers kept up with inflation over longer periods (I mean 15-20 years), medicine has not, at least for physicians.

chess9
11-28-2009, 01:54 PM
Chess9 - I was being sarcastic. :-)

Mikeler - that's the sad reality. A procedure that the market would bear at $2500 in 1983 is lucky to be reimbursed at $1000 now because of non-negotiable Medicare and other factors. Nobody realizes that while most professional careers kept up with inflation over longer periods (I mean 15-20 years), medicine has not, at least for physicians.

Well, all you doctors should be begging for NHS style care then because in England, for instance, most doctors are earning at least $200K a year, and they have no malpractice premiums, no insurance company forms, and only the NHS bureaucracy to deal with. Of course, they are employees, and not the boss. They must answer to non-doctor managers, which totally sucks from my perspective. (I think this is one of the reasons why the NHS does such a poor job.)

-Robert

Steady Eddy
11-28-2009, 02:23 PM
About 2 years ago I got pneumonia and had to spend a week in the hospital. They didn't operate on me, just gave me IV's, and then billed by insurance company $100,000! I don't get that bill. After that, nothing surprises me.

scotus
11-28-2009, 02:28 PM
If the agreement can be drawn up for $750 then you can get a form off the internet and edit it for your needs. You don't need someone with a brain. ;)

For a fairly simple LLC document that can be downloaded off the internet, one lawyer that I hired charged $6000.

My accountant used to do fill out this form himself at no extra cost, but he must have made a business acquaintance, so he told me that I needed to get this done "correctly" and suggested that I hire this lawyer.

After I told him what the lawyer charged me, he apologized profusely and swore that was the last time he ever referred this lawyer to anyone.

chess9
11-28-2009, 02:28 PM
About 2 years ago I got pneumonia and had to spend a week in the hospital. They didn't operate on me, just gave me IV's, and then billed by insurance company $100,000! I don't get that bill. After that, nothing surprises me.

No harm in asking? ;)

-Robert

BreakPoint
11-28-2009, 03:12 PM
The doc has gone through 4yrs college, 4 yrs med school, prob 5 yrs orthopedic residency and didn't prob make any real money till 35+ yrs old.

Med school education prob 200K not including undergraduate college.

pays prob 100K in malpractice,

is at the mercy of whatever insurance wants to pay him.

Works prob 80-100hrs a week

every tom,dick or jane wants to sue him whenever anything doesn't turn out like it should, or just b/c he wasn't nice.

What do you think his services to diagnose and treat your body are worth?
Which is why I think we need tort reform, as well as or before, heath care reform.

yemenmocha
11-28-2009, 03:23 PM
Which is why I think we need tort reform, as well as or before, heath care reform.

Amen to that, Breakpoint. :neutral:

snoopy
11-28-2009, 03:30 PM
I sort of agree, but then I think there shouldn't be a limit on the price a dr should pay for chopping off the wrong leg.

mikeler
11-28-2009, 04:15 PM
I'd prefer tort reform to take place first and then react to the results of that change before pursuing healthcare reform.

yemenmocha
11-28-2009, 04:24 PM
I sort of agree, but then I think there shouldn't be a limit on the price a dr should pay for chopping off the wrong leg.

You can have a lot of tort reform without caps.

Docs are far more worried about the frivolous cases that shouldn't be considered at all. In Europe, I think, there's an early stage where people with medical credentials pre-screen the cases before they go to a further stage. That needs to take place here. Average citizen in a jury is an idiot, and that's partly why some of the joke cases are won and/or settled for $ when they should have never received serious consideration at all. People are incapable of deciding based on the merits of the case vs. sympathy for the plaintiff.

There's also the well-known issue of practicing excessively defensive medicine because of fear of lawsuits. That drives up costs unnecessarily.

The minor tangential stuff needs changed too, such as being "named" in a case that really isn't about you. You still have to get an attorney and still endure the damn process, even though you're not directly being sued.

The process is incredibly flawed, and the cases without merit are far more common than "chopping off the wrong leg".

jazzyfunkybluesy
11-28-2009, 04:28 PM
I broke my leg 4 years ago, stayed 2 nights at the hospital- The bill was 25 USD :)

That makes the OP really happy.:shock:

borg number one
11-28-2009, 05:07 PM
Don't fall for the Tort reform will really help health care reform mantra. It won't work in terms of lowering insurance premiums.

See articles on this oft-debated topic:
http://www.redding.com/news/2009/aug/31/bob-williams-the-holy-grail-of-tort-reform/?partner=RSS

http://www.kellogg.northwestern.edu/faculty/dafny/personal/Documents/Working%20Papers/ADS_9_09w_ack.pdf

http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/

You know who has pushed Tort Reform? The Republican Party, Conservatives, Big Business, Insurance Companies, and many Physicians. I wonder why?

Meanwhile, Tort Reform in the U.S. has not hugely impacted Attorneys who handle a lot of med mal cases. Attorneys can handle a wide variety of cases by and large, so most of them feel little if any real "financial impact" from Tort Reform. Heavy Hitters in that arena have plenty of other work to pursue. Most all of them that I have met and worked with truly do care deeply about patients that have been severely injured due to medical malpractice.

They seek justice and HATE the idea of trying to pursue frivolous lawsuits. There are simply too many good cases to pursue and they surely do not want to sink hundreds of thousands of dollars into a "dog" case. Why would they want to do that, even from business perspective?

When Tort Reforn occurs in one state. Guess what tends to occur. Bad Doctors from a State that has not enacted Tort Reform, whose malpractice insurance premiums are skyrocketing due to court losses, move to the State with Tort Reform, so they can somehow obtain malpractice insurance and continue to practice.

So, such Tort Reform states tend to basically attract more bad doctors, who are in the minority overall. The AMA needs to do a much better job of policing its own doctors to make sure "repeat offenders" can't continue practicing and hurting patients.

You know who gets hurt most by Tort Reform? Injured Patients due to Medical Malpractice, which 99% of the time goes ABSOLUTELY UNDETECTED.

There is even falsification of medical records when it is even suspected at hospitals/clinics. That's one of the first things I saw in a Law School Course I took, that was taught by a Law Professor, whose father was a Doctor, and who often lectured at the Texas Medical Center to assist Physicians learn more about the interplay between the Law and Medicine. Be careful when those medical records come back a little too neat and tidy! I've seen this up close and personal with many cases I have personally handled. The "cover ups" can be outrageous and shocking to witness.

What would doctors do/What do doctors do when malpractice hits their own families (say a wife during pregnancy or her delivery)? Oh yeah, they hire a lawyer often to pursue a malpractice case against a fellow physician.

Here is some information to consider:

Health Care Costs are out of control:
http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358

Insurance Premiums have DOUBLED since just 2000:
http://www.commonwealthfund.org/Content/News/News-Releases/2009/Aug/Employer-Sponsored-Health-Insurance-Premiums-Increase-119-Percent.aspx

If Health Care Costs and Insurance Premiums are not tamed, it will further bankrupt the Country and working families.

chess9
11-28-2009, 06:18 PM
Don't fall for the Tort reform will really help health care reform mantra. It won't work in terms of lowering insurance premiums.

See articles on this oft-debated topic:
http://www.redding.com/news/2009/aug/31/bob-williams-the-holy-grail-of-tort-reform/?partner=RSS

http://www.kellogg.northwestern.edu/faculty/dafny/personal/Documents/Working%20Papers/ADS_9_09w_ack.pdf

http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/

You know who has pushed Tort Reform? The Republican Party, Conservatives, Big Business, Insurance Companies, and many Physicians. I wonder why?

Meanwhile, Tort Reform in the U.S. has not hugely impacted Attorneys who handle a lot of med mal cases. Attorneys can handle a wide variety of cases by and large, so most of them feel little if any real "financial impact" from Tort Reform. Heavy Hitters in that arena have plenty of other work to pursue. Most all of them that I have met and worked with truly do care deeply about patients that have been severely injured due to medical malpractice. They seek justice and HATE the idea of trying to pursue frivolous lawsuits. There are simply too many good cases to pursue and they surely do not want to sink hundreds of thousands of dollars into a "dog" case. Why would they want to do that, even from business perspective.

When Tort Reforn occurs in one state. Guess what tends to occur. Bad Doctors from a State that has not enacted Tort Reform, whose malpractice insurance premiums are skyrocketing due to court losses, move to the State with Tort Reform, so they can somehow obtain malpractice insurance and continue to practice.

So, such Tort Reform states tend to basically attract more bad doctors, who are in the minority overall. The AMA needs to do a much better job of policing its own doctors to make sure "repeat offenders" can't continue practicing and hurting patients.

You know who gets hurt most by Tort Reform? Injured Patients due to Medical Malpractice, which 99% of the time goes ABSOLUTELY UNDETECTED. There is even falsification of medical records when it is even suspected at hospitals/clinics. That's one of the first things I saw in a Law School Course I took taught by a Law Professor, whose father was a Doctor, and who often lectured at the Texas Medical Center to assist Physicians learn more about the interplay between the Law and Medicine. Be careful when those medical records come back a little too neat and tidy! I've seen this up close and personal with many cases I have personally handled. The "cover ups" can be outrageous and shocking to witness.

What would doctors do/What do doctors do when malpractice hits their own families (say a wife during pregnancy or her delivery)? Oh yeah, they hire a lawyer often to pursue a malpractice case against a fellow physician.

Here is some information to consider:

Health Care Costs are out of control:
http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358

Insurance Premiums have DOUBLED since just 2000:
http://www.commonwealthfund.org/Content/News/News-Releases/2009/Aug/Employer-Sponsored-Health-Insurance-Premiums-Increase-119-Percent.aspx

If Health Care Costs and Insurance Premiums are not tamed, it will further bankrupt the Country and working families.

Yup. Very good post.

Most states already have engaged in MAJOR malpractice reform. Like 40 years ago. Tort reform won't help doctors much at all unless caps are established at $250K or less, and that ain't happening. Very few medical malpractice cases actually get to the trial stage. Most are dismissed by either the plaintiff's lawyer or the courts. Appeals are rare, and granting the appeals is even rarer. Doctors are being ripped off more by their insurance carriers than by the courts. Take a closer look at the expenses of the major doctor owned/run malpractice carriers, as in Cali. The doctors/managers are making a bundle and the amount paid out for claims is less than 50% of revenues in many cases. And, the market is very limited. Insurance carriers can pretty much charge what they want to charge. The degree of collusion and monopoly power is high. Doctors ripping off doctors. This is one reason why every good doctor needs a damned fine lawyer. ;)

-Robert

yemenmocha
11-28-2009, 07:36 PM
Only one of those in the first set was a real "article". OP-eds are entertaining but certainly not articles, even if it's an academic who is giving his opinion. There's plenty of room for debate on this, and some of the same researchers' data is used for opposing views (Kessler & McClellan, for example: http://www.aaos.org/news/aaosnow/sep09/reimbursement4.asp)

I don't think $100+ billion is chump change, or should be diminutively referred to as a "rounding error", even if it is only 1-2% of healthcare costs. Many other well-regarded studies place the dollar amounts higher and the % higher, especially with the defensive medicine estimates factored in. At a minimum, this is large debate, and not some slam dunk in favor of "we don't need tort reform".

And even if the 1-2% estimate is correct, and that's the major complaint from the medical community, then FFS why not just fix it. If the major complaint is such a minor one, and then they'll STFU, then fix it. It's like Dr.Evil demanding just ONE MILLION dollars to not destroy the earth, and yet the negotiators won't give in. If it's only a small percentage, then just fix it. But I suspect that either the data isn't right, or the people who will lose out if that $100+billion is no longer there for the taking. Who would that be?

As I said earlier, it doesn't necessarily just have to be about caps. Maybe that's the most effective way of having the quasi-trickle down effect where the smaller cases never get seen, but something has to be done about cases with little merit having the influence that they do. Every physician I know has had one like this or knows physicians who have had them. This isn't some urban myth or hasty generalization from a few small instances. Some of the most absurd cases get settled with decent payouts, and ironically I've seen that with appendicitis cases somewhat similar to the one mentioned in the above "article".

If a medically credentialed committee existed that would serve as an early filter for sifting out the cases lacking appropriate merit in terms of the medical fault (such as there is in Europe), then you the attorneys would have nothing to fear and nothing to lose - because according to those in the articles posted above, very very few cases are frivolous. If so, then pretty much everything would still get through, so you should have no worry about a loss of business for yourselves. But if the critics are right that a lot of cases are frivolous, then such a committee would be a good idea. It would probably give peace of mind to physicians to not practice excessively defensive medicine because the proper criteria would be in place -whether in fact a medical mistake was made, and not whether a jury of laypeople would possibly side with the plaintiff over some "rich doctor".

The general public doesn't seem to understand that doctors can do everything they're supposed to do and more, and still get sued. That, as a system, is broken. There's no confidence that doing what one is supposed to do will guarantee no lawsuits. It's sad that this isn't so.

chess9
11-29-2009, 05:19 AM
Yemenmocha:

Most states already have a medical malpractice review panel, with doctors on board, who review claims.

The largest single issue with doctors and the malpractice problem is they rarely lose their licenses. Get rid of bad doctors and you can cut a lot of the costs. You have a small number of bad apples who are not only giving good doctors a bad name but are raising the costs for good doctors.

Should Michael Jackson's doctor still be practicing medicine? ;) And he's probably one of the weaker examples. I had a triathlete buddy of mine who was a defense lawyer for a large malpractice carrier tell me that the mistakes he's seen doctors make should be crimes, yet the burden on plaintiff's counsel is so difficult, many of the doctors (meaning their carriers) don't pay a red cent. I wasn't a negligence lawyer, but I'm sure the defense and plaintiff's negligence bar could regale us with scary stories. I'd like to see doctors work as hard to improve their licensing standards as they are to lower malpractice costs.

Btw, ANYONE can get sued at any time. Some states have instituted 'frivolous case' rules to charge the costs of filing such suits to the lawyer and his client. But, that's a difficult issue because one man's frivolity, is another man's bread and butter.

-Robert

chess9
11-29-2009, 06:11 AM
Just in case anyone doubts the death of healthcare reform, look here:

http://news.yahoo.com/s/ap/20091129/ap_on_bi_ge/us_health_care_overhaul

I don't see the votes for reform, and if they pass anything it will be innocuous pap to try to please a few politicians.

-Robert

borg number one
11-29-2009, 06:43 AM
Great personal insights Chess9. You are exactly right as to the above. I agree with what you are touching on above as to medical malpractice.

The truth is that as to "defensive medicine", procedures/testing, while possibly reducing the POSSIBILITY of a lawsuit (because nothing is missed), there are real financial incentives for having such procedures/tests done. What happens when such "defensive medicine" tests/procedures are implemented? Hospitals/Doctors make more money. Plus, Insurance Carriers, though they have added expenditures, they pass on these costs to their policy holders in the way of very high insurance premiums (malpractice and health insurance premiums).

Though Hospitals/Doctors point to "extra" procedures and testing such very expensive CT Scans and MRI's which are not always REALLY necessary, due to "defensive medicine", the truth is that there is ALSO a real financial incentive for ordering such procedures. Doctors and Hospitals never like to talk about the real financial incentives for ordering such "defensive medicine" tests/procedures, but they are real

This is a complicated issue, and in the end, as articles often point out, the real costs of the practice of defensive medicine are not "insignificant" but they are also not "overwhelming". There are some added costs due to the practice of defensive medicine though, but having some added safety in my mind can be worth it, because a lot of medical malpractice does in fact exist and goes undetected by patients/families.

Why should the field of medicine have rules and their own panels that would in effect set up a separate judicial system? We don't have for example architecture courts, or civil engineering courts do we? Such cases also deal with highly complex issues at times presented to juries. Also, some criminal cases are very complicated and involve complicated science in the way of forensics, but juries are expected to wade through the science and emotional side of such cases, aren't they?

Medical malpractice cases involve the use of medical experts, who often must be specialized in the specific medical field that is involved in the instant case, so it's not as if there is a lot of "junk science/medicine" being used in Courtrooms. Doctors are heavily involved in these cases that go to the trial stage. Juries must assess credibility first and foremost and over time, they more often than not do get it right, especially when a Doctor does not meet the standard of care that is at play. That is the key question to be answered.

See a book on this very topic. This weblink summarizes some of the highlights:
http://www.bsos.umd.edu/gvpt/lpbr/subpages/reviews/baker0306.htm

Also see:
http://medicalmalpracticelawblog.com/2008/10/31/statistics-on-medical-malpractice-lawsuits/

Key Excerpt From the Weblink Above:

"The Journal of the American Medical Association (JAMA) produced an article highlighting these medical malpractice lawsuit statistics, with regard to patient deaths:

* 106,000 patients die each year from the negative effects of medication
* 80,000 patients die each year due to complications from infections incurred in hospitals
* 20,000 deaths per year occur from other hospital errors
* 12,000 people die every year as a result of unnecessary surgery
* 7,000 medical malpractice deaths per year are attributed to medication errors in hospitals

This totals up to 225,000 deaths each year, due to medical negligence of some nature. And that number is ever growing.

In 2006, a report was produced by the Institute of Medicine of the National Academies, in which it is stated that medication errors are one of the most common medical mistakes, causing injury or harm to at least 1.5 million people every year."

mikeler
11-29-2009, 02:53 PM
I wonder if a system where the losing party pays legal costs for both parties would be better?

heycal
11-29-2009, 03:42 PM
$456! Incredible. I cannot believe it....

-Robert

The long arm of the tennis elbow finally caught up with ya, huh?

Did I read right that you got the controversial cortisone shot?

borg number one
11-29-2009, 03:45 PM
Mikeler, there are real problems with that idea in med mal cases. There are also problems with having the "loser" pay all expenses with Negligence cases in general.

1. Plaintiffs with no money have only one way of pursuing legal action if they are injured, that is having a Plaintiff's Lawyer willing to take the risk of taking on a case, and spending lots of time (could be more than one year or years) and paying costs (medical experts, depositions, administrative costs, etc.) all UP FRONT. The Lawyer has the realization that even with a good case, there is the potential for the Plaintiff to prevail only say 2 years after first filing suit. So, the use of "Contingency Contracts" are the only method by which those that are poor can gain legal representation. Contingency Contracts involve the Attorney getting paid only if successful and then the client's fees are subtracted out of the total award as a percentage, say 40% after filing suit, or 1/3 if settled prior to litigation.

2. Meanwhile, the Defendant (s) in a medical malpractice scenario are typically defended by either an Insurance Company Attorney (the ins. co. has extended a policy to the insured doctor) or perhaps a personal Attorney if the Insurance Carrier does not cover the malpractice at issue.

So, either way, the Defendant in this situation typically has a slight financial advantage in that they have more resources at his/her disposal. Yet, some Plaintiff's Lawyers have very deep pockets after much success with many cases, so they can go toe to toe with the Defendant as far as spending money on the case.

3. In some cases of negligence, the Defendant if he/she prevails, can have the Plaintiff pay the attorney's fees. The same can be true if the Plaintiff prevails. In certain cases, the Defendant will be asked by the Court to pay the Plaintiff's attorney's fees.

So, there is a real disincentive to bringing a case that is unlikely to prevail, from just a financial perspective. Given that in most States, it is extremely difficult to prevail at trial as a Plaintiff against a Physician (e.g. Conservative Texas has all Republicans on its Supreme Court currently), and that it is extremely difficult very often to get another Doctor in the same specialty as the Defendant Physician to testify against a "peer" as to his/her negligence, the odds are not very good as far as prevailing at trial already.

If you were to have Plaintiffs forced to also pay all the expenses/attorney's fees to the Defendant when they lose a med mal case, you would have two central problems:

1. The Defendant has an incentive to "rack up excessive costs" to discourage the Plaintiff with continuation of the suit.

2. There would be even fewer Plaintiffs' Lawyers who would be willing to take on an already risky/expensive medical malpractice case of a Plaintiff, even when the malpractice is fairly clear cut.

Having a real bona-fide case of malpractice that has resulted in substantial injury still leaves one a long way from prevailing at trial. It can still be a very risky proposition that could take years, especially with the appeals process. So these are just some of the central problems I see with such a proposal.

mikeler
11-29-2009, 04:27 PM
Very clear and concise points borg number one. Thanks for spending the time on your response. It is a complicated situation which is why I posed the question.

borg number one
11-29-2009, 06:39 PM
No problem Mikeler, my pleasure. I'm glad I could throw my two cents in as to that idea. It is not a "perfect" system and the best solution is to somehow decrease the INCIDENCE of malpractice in the first place. It's akin to practicing preventive medicine, as opposed to trying to treat diseases/severe symptoms AFTER the fact.

chess9
11-30-2009, 04:15 AM
The long arm of the tennis elbow finally caught up with ya, huh?

Did I read right that you got the controversial cortisone shot?

You are sooo late getting here. Remind me to not play doubles with you. ;)

Golfer's elbow, not tennis elbow. ;)

Yes, after never having had elbow problems my entire life, I framed a ball hitting a forehand and my hand supinated violently causing massive pain in the medial epicondyle. :) I'm in recovery mode now. From now on I'll only play 4.0s and below and hit pitty-pat forehands, I guess. :( Getting old totally sucks.

-Robert

borg number one
11-30-2009, 04:40 AM
Chess9, don't write yourself off so quickly!!

Has your Doctor already given you such a prognosis? Just remember, rest often does wonders. Plus, besides physical therapy, don't overlook acupuncture.

Many have told me how it has really helped them in such instances, and its been used for centuries in the Orient.

In fact, recently, I took my mom for a couple of sessions, because of a arthritic condition that was causing pain to radiate down from her neck to her shoulder and elbow region, due to overstraining her right arm (likely aggravated wiping too hard on kitchen surfaces using with her right arm). She got better after about a month, after having a lot of "tennis elbow" like pain and also pain in her neck, right shoulder and arm.

Here's what really helped her:

1. Keeping the area warm as much as possible. A "wrap" can really help.
2. Avoiding cold air from always keeping her entire arm cold during the day (A/C).
3. Acupuncture sessions.
4. Simple rest and recovery, avoiding such strenuous motions.

She stopped taking ANY prescription pain medications, because she hates the side effects.

See if any or all of the above helps you while you recover. Seriously, check into going in for a few acupuncture sessions with someone licensed, along with the medical advice you get from your doctor. Sometimes such a "combined approach" can be most effective.

chess9
11-30-2009, 05:28 AM
Borg:

Thanks, mate, but I'm 99% healed. I played two sets two days ago and will play doubles this afternoon in the warmth of the day. I've found rest is important. Also, I think a minimum of 4-6 weeks rest is important. It's so easy to jump back into playing because some of us have friends calling daily for a hit. My Spanish doctor buddy has called me almost daily hoping I'm better, and I'm supposed to play a ladder tournament next weekend so the guys are asking me if I will be playing as they need doubles partners. So, the pressure to play seems enormous, and at my age one can only lift weights and run so much.

-Robert

mikeler
11-30-2009, 05:31 AM
My GE was really bad in a match 16 days ago. I've done 5 sessions of ultrasound and electrostimulation therapy. My chiropractor was closed on Friday. Had I got that 6th session, I think I'd be pain free today. My GE is now just minor discomfort and only when I make certain arm movements. Going to schedule an appointment today and then see how it feels tomorrow. It really worked for me. Looking forward to getting back on the court soon.

borg number one
11-30-2009, 06:18 AM
Good deal Chess9. I'm glad you are back on the courts. Yes, simply "working out" is not NEARLY as fun as being out on the Courts, feeling the sun on your face and just being out in Nature. I swear that sometimes when I'm really enjoying myself on the Tennis Court I think to myself, "this is about as good as it gets". Thanks for the update, it sounds like you'll be fine.

heycal
11-30-2009, 01:18 PM
You are sooo late getting here. Remind me to not play doubles with you.

Golfer's elbow, not tennis elbow.

Yes, after never having had elbow problems my entire life, I framed a ball hitting a forehand and my hand supinated violently causing massive pain in the medial epicondyle. I'm in recovery mode now. From now on I'll only play 4.0s and below and hit pitty-pat forehands, I guess. :( Getting old totally sucks.

-Robert

I consider GE to be under the TE umbrella, so I'm sticking with my original description.:)

You got a shot of cortisone? If so, do you think it did anything?

charliefedererer
11-30-2009, 01:50 PM
Borg:

Thanks, mate, but I'm 99% healed. I played two sets two days ago and will play doubles this afternoon in the warmth of the day. I've found rest is important. Also, I think a minimum of 4-6 weeks rest is important. It's so easy to jump back into playing because some of us have friends calling daily for a hit. My Spanish doctor buddy has called me almost daily hoping I'm better, and I'm supposed to play a ladder tournament next weekend so the guys are asking me if I will be playing as they need doubles partners. So, the pressure to play seems enormous, and at my age one can only lift weights and run so much.

-Robert

Glad to hear you're 99% better.
I still think this mishit was a freak ocurrence, and puts you at a much lower risk for recurrence than most as long as you let it fully recover.
I have gotten the Flexbar blue and a hand gripper to work my forearm muscles to prevent TE/GE problems as I realized I lock my wrist from going past neutral both plalying tennis and lifting (except for probably way too few wrist curls with dumbells). Did you end up getting a flexbar, and what did you think of it if you did?

bee
11-30-2009, 02:54 PM
The retired attorney complaining about the doctors again.

My divorce attorney charged me for every time I called him on the telephone. Can you imagine if I charged patients every time I talked with them on the telephone?

Where's the change? The change you can believe in?

charliefedererer
11-30-2009, 02:57 PM
The retired attorney complaining about the doctors again.

My divorce attorney charged me for every time I called him on the telephone. Can you imagine if I charged patients every time I talked with them on the telephone?

Where's the change? The change you can believe in?

I propose the bickering about doctor and lawyer charges end on the health and fitness site. Anyone who wants to continue can do so in the rant and rave section.

chess9
11-30-2009, 03:03 PM
Glad to hear you're 99% better.
I still think this mishit was a freak ocurrence, and puts you at a much lower risk for recurrence than most as long as you let it fully recover.
I have gotten the Flexbar blue and a hand gripper to work my forearm muscles to prevent TE/GE problems as I realized I lock my wrist from going past neutral both plalying tennis and lifting (except for probably way too few wrist curls with dumbells). Did you end up getting a flexbar, and what did you think of it if you did?

I played three sets of doubles today at the 4.0 level and just pushed the ball around gently for the most part. No hard forehands. Towards the end of the third set I started feeling it so I stopped though the guys wanted me to play a fourth. I'm going to take a few more days off, however, as on some of the harder forehands I'm feeling some slight stinging.

No, I didn't buy the Flexbar, as I lift and am now doing the wrist curls and pushdowns and massaging it with an electronic massager that seems to be helping. I also just finished icing it and it feels fine. I can pick up coffee cups and stuff, and can do wrist curls at 20 x 25lbs. easily with no pain. I can also touch my right shoulder with my right hand, which I'm told is a helpful sign. Oh, I've been doing something else. After tennis, when I take my shower I wash my shirt in the shower and twist it in my hands to wring it out. I suspect that's similar to the flexbar routine. Saves on washing too. ;)

-Robert

charliefedererer
12-01-2009, 06:44 AM
Oh, I've been doing something else. After tennis, when I take my shower I wash my shirt in the shower and twist it in my hands to wring it out. I suspect that's similar to the flexbar routine. Saves on washing too. ;)

-Robert

Very clever.

I've left my flexbar and handgripper in the family room, and played with them during the ATP tournament and last night during the Saints thrashing of the Patriots. I more commonly am reading/working than the TV is on, and this last week probably involved more time actually viewing than I'll do until the AO. But they also make a nice brake from work.

mikeler
12-01-2009, 07:19 AM
Hit for the first time yesterday for 5 minutes. I was afraid to swing out on my forehand but everything felt fine. My arm was still kind of numb from the electrostimulation therapy a half hour earlier. The pain is just about gone. I plan on going twice more and then just gradually getting back into hitting again.

chess9
12-01-2009, 07:25 AM
I consider GE to be under the TE umbrella, so I'm sticking with my original description.:)

You got a shot of cortisone? If so, do you think it did anything?

Yes, I do. I suspect it helped to speed the process, but simply resting for two months probably would have done the same FOR ME. Your mileage may vary, as they say. However, I might have gone insane in two months. ;) Or, died of boredom.

-Robert

chess9
12-01-2009, 07:26 AM
Hit for the first time yesterday for 5 minutes. I was afraid to swing out on my forehand but everything felt fine. My arm was still kind of numb from the electrostimulation therapy a half hour earlier. The pain is just about gone. I plan on going twice more and then just gradually getting back into hitting again.

Good on ya' to limit your hitting. Coming back very slowly helps, IMHO. The first few times I hit was for 15-30 minutes.

-Robert

yemenmocha
12-01-2009, 07:30 AM
Which electronic massager do you use? Can you recommend a model? Does it have a heat source?

mikeler
12-01-2009, 08:00 AM
Which electronic massager do you use? Can you recommend a model? Does it have a heat source?


It was at a chiropractor. I will look at the model next time I'm there.

borg number one
12-04-2009, 10:31 AM
http://www.google.com/hostednews/ap/article/ALeqM5hdgni2jdm4kvnmvjPGs-wL8n6gEwD9CCIC103


Health care issues: Medical cost inflation

By The Associated Press (AP) – 3 hours ago

A look at key issues in the health care debate:

THE ISSUE: Why do medical costs increase at a rate faster than inflation?

THE POLITICS: Health care spending over the past year increased by 3.2 percent even as overall consumer prices dropped 2.1 percent. That's not unusual in the United States, where health care spending rises at rates substantially higher than inflation. Analysts agree on any number of reasons for the increases, but tend to disagree on which cause is most responsible. Among the reasons:

_Americans get too much unnecessary care — too many tests, treatments and hospitalizations that do not improve their health. The reasons for this vary: Many doctors have a financial interest in new technology, doctors and hospitals fear malpractice lawsuits and patients are indiscriminate consumers because they are shielded from health care costs through insurance or government health plans.

_Easy access to expensive new medical technologies.

_Inefficient health insurance companies with high administrative costs that don't have anything to do with actual health care.

_Unhealthy living habits that strain the system, including smoking and obesity.

WHAT IT MEANS: Curbing the rising costs of health care is at the heart of the current debate on overhauling the nation's health care system. Rising costs have placed Medicare, the federal government insurance program for the elderly, on an unsustainable trajectory that would be responsible for exploding government deficits. The 2009 Medicare trustees' report estimated that Medicare's giant trust fund that pays for hospital care will become insolvent in 2017. At that point, income from payroll taxes will cover only 81 percent of projected costs. The insolvency date moved up two years as a result of the recession.

Employers and their workers have met with rising health insurance costs that are straining business and family budgets.

_ By Jim Kuhnhenn

Copyright 2009 The Associated Press. All rights reserved.

mikeler
12-04-2009, 10:51 AM
I have my last chiropractor visit today. I can barely feel any pain, but I just want to zap it once more before I try and hit some balls this weekend.

chess9
12-04-2009, 10:51 AM
Good article, but nothing in that about doctors charging an arm and a leg. ;) Specialists in particular.

-Robert

chess9
12-04-2009, 10:53 AM
I have my last chiropractor visit today. I can barely feel any pain, but I just want to zap it once more before I try and hit some balls this weekend.

Good luck, mate. I'm back to tennis on Monday. I'm resting, more or less, all week, except for lifting and running. I was able to wrist curl 30 lbs today with no pain, which is a very good sign.

-Robert

mikeler
12-04-2009, 11:06 AM
Good luck, mate. I'm back to tennis on Monday. I'm resting, more or less, all week, except for lifting and running. I was able to wrist curl 30 lbs today with no pain, which is a very good sign.

-Robert


Thanks Robert, glad you are doing better too. After living with the pain for a year I'm still in disbelief that it is almost completely gone without the use of cortisone pills.

scotus
12-04-2009, 11:20 AM
Good article, but nothing in that about doctors charging an arm and a leg. ;) Specialists in particular.

-Robert

I think the cortisone shot falls under the category of surgery, hence a higher charge.

chess9
12-04-2009, 12:31 PM
I think the cortisone shot falls under the category of surgery, hence a higher charge.

Sheezh....

-Robert