98% of the American population doesn’t know the following information: 1. Health systems, PBMs, and carriers want and need prices to continually increase. 2. Medicare pays health systems 3-5x more than private practice physicians for the same treatments. 3. New physicians contracting with Medicare receive significantly less than 100%. 4. As of 2010, physicians may not own hospitals. 5. The cap on residency budgets has existed since 1997. 6. Coverage is not care. 7. The vast majority of lawmakers are owned by the healthcare lobby. 8. 33 states still have CON laws that prohibit competition in healthcare. 9. Price transparency laws have been on the books for 3 years and the laws are not obeyed. 10. The difference between self-insured and fully-insured. Keep posting & keep educating.
I'm not sure what you mean when you say: "3. New physicians contracting with Medicare receive significantly less than 100%." As far as I am aware, every physician is paid at the professional fee schedule rates whether they are newly enrolled or have been in practice for 30 years. However, if you are referring to Medicare Choice plans (Medicare Advantage, Medicare HMO, etc.) CMS has nothing to do with those fee negotiations. Those health plans buy services on a market rate basis by zip code. Supply versus demand. As far as I know, every industry does this.
Bill Hennessey, M.D. can help.
....12 have any idea of hcpc, icd10's , multipliers, drg's etc. we built a system that leaves the customer/client/insured in the dark. OZ is behind the curtain : )
I'm not sure what you mean when you say: "2. Medicare pays health systems 3-5x more than private practice physicians for the same treatments." If you are referring the the physician fee schedule, that is not true. There is a lower fee schedule for professional services and the hospital bills a facility fee. But, I assure you, in combination of both, it is not 3-5x more.
Thanks for sharing Dutch Rojas and continuing to educate about the crazy complexities of of our sick care system.
#7 explains why Americans pay the most of healthcare and are not actually healthy for a first world country
#5 has destroyed access. #9 is criminal.
The next generation of decision makers does not have this information. Never give up. Well stated Dutch.
Fascinating post Dutch Rojas. Interested in more of your thoughts on #10. I’ve always found it a weird quirk of our system that most large employers are effectively health insurers. Do you think one provides a better system for individuals and providers? Seems like there’s more innovation driven by the employer market.
Consultant at Linda Tieman LLC
1yDo I have to know how to make a toaster in order to make toast? How much detail does the average person need to know?