Shady Hospital Practices

[kieselguhr]

Originally Posted by Abdullah71601

In the US: Last summer I was taken to the ER with chest pains and diagnosed with angina. It took four weeks to get in to see the cardiologist. Then three weeks to schedule a stress test. Three more weeks to schedule a heart cath. And three more weeks to see the cardiologist to tell me what the diagnosis was. Three months (and $7000 out of pocket) to learn that I do not have any heart problems (turned out to be esophageal spasms).



Maybe you have to wait a month, but at least the NHS is a free service.

Sorry to hear about your experience. Unfortunately a consequence of being non cardiac. It would be a very different story if your EKG actually showed an ST elevation and was verified by an interventional cardiologist. At that point it is standard of care across the board from initiation of STEMI call to balloon time of 90 minutes. Most hospitals accomplish this in less than an hour.


AOW

[TheVTCGuy]

I have had the same Urologist for probably 15 years. He left and I went to the same office to see the new one. I have had five kidney stones in my lifetime and suffer from semi-frequent prostititus. Stones run in my family and I am subject to Prostate flare ups when I get stressed. It sucks, but everyone has their things and that’s mine; I deal with it. My old doc would prescribe me Tramadol, or Heavy-dose Ibuprofen, one bottle of each would last me about a year. The new doc makes me take a 24 hour test (OK, that’s fine), the results were normal. Then wants to do a CT scan, and do another 24 hour collection. I’m feeling fine by the way and just went in for my yearly prostate exam and check up. He also says he won’t refill my Tramadol prescription... OR my IBUPROFEN. WTF? I really got the impression all he was interested in was charging the insurance company for visits and tests, and it’s ridiculous not to prescribe one bottle a year of a very mild pain reliever and Ibuprofen for God’s sake. My primary care guy laughed, prescribed me both and referred me to a new Urologist.

[Keadog]

Originally Posted by TheVTCGuy

I have had the same Urologist for probably 15 years. He left and I went to the same office to see the new one. I have had five kidney stones in my lifetime and suffer from semi-frequent prostititus. Stones run in my family and I am subject to Prostate flare ups when I get stressed. It sucks, but everyone has their things and that’s mine; I deal with it. My old doc would prescribe me Tramadol, or Heavy-dose Ibuprofen, one bottle of each would last me about a year. The new doc makes me take a 24 hour test (OK, that’s fine), the results were normal. Then wants to do a CT scan, and do another 24 hour collection. I’m feeling fine by the way and just went in for my yearly prostate exam and check up. He also says he won’t refill my Tramadol prescription... OR my IBUPROFEN. WTF? I really got the impression all he was interested in was charging the insurance company for visits and tests, and it’s ridiculous not to prescribe one bottle a year of a very mild pain reliever and Ibuprofen for God’s sake. My primary care guy laughed, prescribed me both and referred me to a new Urologist.

OTC ibuprofen is identical to Rx drug. OTC capsule are 200 mg and Rx dose is around 800, IIRC.
Tramadol is another thing.

[AK797]

Originally Posted by timedate

its not free, you must know this by now.

Compared to the alternative it's the freeist thing in all of freetown.

[Burlington]

The uk system isn’t perfect, how can something that large and complex ever be. But it’s one of the best healthcare systems in the world. 90% of the challenge is people don’t realise just how lucky it is to have free at the point of use healthcare.

[TheVTCGuy]

Originally Posted by Abdullah71601

In the US: Last summer I was taken to the ER with chest pains and diagnosed with angina. It took four weeks to get in to see the cardiologist. Then three weeks to schedule a stress test. Three more weeks to schedule a heart cath. And three more weeks to see the cardiologist to tell me what the diagnosis was. Three months (and $7000 out of pocket) to learn that I do not have any heart problems (turned out to be esophageal spasms).

Maybe you have to wait a month, but at least the NHS is a free service.

I’m with you. When my Diverticulitis was not responding to antibiotics last summer I was referred to a Gastro, SIX WEEKS was the first appointment. He wanted a colonoscopy; FOUR WEEKS for that. Keep in mind my life was a living hell. Then had to make an appointment to see the Gastro to go over the results of the oscopy. FOUR MORE WEEKS. He tells me it’s very bad and I need surgery. Thanks, three months of being miserable to be told I have to have part of my intestines removed.

[Blansky]

Originally Posted by TheVTCGuy

I’m with you. When my Diverticulitis was not responding to antibiotics last summer I was referred to a Gastro, SIX WEEKS was the first appointment. He wanted a colonoscopy; FOUR WEEKS for that. Keep in mind my life was a living hell. Then had to make an appointment to see the Gastro to go over the results of the oscopy. FOUR MORE WEEKS. He tells me it’s very bad and I need surgery. Thanks, three months of being miserable to be told I have to have part of my intestines removed.

Can't you just go to the emergency room and get better care. I realize it can cost more.

[TheVTCGuy]

Originally Posted by Keadog

OTC ibuprofen is identical to Rx drug. OTC capsule are 200 mg and Rx dose is around 800, IIRC.
Tramadol is another thing.

I understand, I can get the same IBPV dose by taking four 200MG of Advil, it’s just the convenience of taking one pill versus four. And... Won’t give me a prescription for IBUPROFEN!?!?! I didn’t realize it was a controlled or addictive substance. Now, the Tramadol I understand a LITTLE bit, it is a prescription only medicine, but a very mild one. I am not even sure it is considered an Opioid. (Anyone know?). But two points: First, we are talking Tramadol, NOT Fentanyl, second, ONE BOTTLE A YEAR!? He had my records, he saw how much the previous Urologist had prescribed me, I am not exaggerating when I say it was ONE BOTTLE PER CALENDAR YEAR. I hardly consider myself at risk for addiction at that rate. As I said, I told my GP (whom I have been with for probably ten years) and he literally laughed, then wrote me a prescription for both. That was in January, I have two-thirds of the IBPV left and half a bottle of Tramadol... in six months. And, OBTW, had major surgery in May so used some of the Tramadol for low-level pain. Seriously, I don’t understand what that new Urologist was thinking. I moved on to a new one.

[TheVTCGuy]

Originally Posted by Blansky

Can't you just go to the emergency room and get better care. I realize it can cost more.

You are right, for pain, and more antibiotics, but my Doc (whom I trust) said I needed to see the specialist (Gastro), ERs don’t have them that I know of.

[Zakalwe]

I’m surprised to hear the stories from American TRF-ers about having to wait lengthy periods for stuff to get done.

If you actually look at overall clinical outcomes, the US and U.K. have very similarly performing health services. There are some areas where one outperforms the other but by and large your chances of being treated effectively for any given condition is similar on either side of the pond.

The difference is how people pay. Americans pay in dollars and Brits pay in time. Yes, the NHS isn’t free but it’s vastly cheaper and more efficient than the US system. But the benefit of that inefficiency should surely be that you get your consultations and tests stat. If you’re paying both in dollars and in time then that’s the worst of both worlds.

[kieselguhr]

Originally Posted by TheVTCGuy

I understand, I can get the same IBPV dose by taking four 200MG of Advil, it’s just the convenience of taking one pill versus four. And... Won’t give me a prescription for IBUPROFEN!?!?! I didn’t realize it was a controlled or addictive substance. Now, the Tramadol I understand a LITTLE bit, it is a prescription only medicine, but a very mild one. I am not even sure it is considered an Opioid. (Anyone know?). But two points: First, we are talking Tramadol, NOT Fentanyl, second, ONE BOTTLE A YEAR!? He had my records, he saw how much the previous Urologist had prescribed me, I am not exaggerating when I say it was ONE BOTTLE PER CALENDAR YEAR. I hardly consider myself at risk for addiction at that rate. As I said, I told my GP (whom I have been with for probably ten years) and he literally laughed, then wrote me a prescription for both. That was in January, I have two-thirds of the IBPV left and half a bottle of Tramadol... in six months. And, OBTW, had major surgery in May so used some of the Tramadol for low-level pain. Seriously, I don’t understand what that new Urologist was thinking. I moved on to a new one.

OTC or not it’s still a medication that has potential for side effects. What if you’re on blood thinners and the physician has no idea. Congratulations, you now have a GI bleed, or worse. Of course you can go ahead and purchase them over the counter and use them on your own volition as I highly doubt you will sue yourself.


AOW

[TheVTCGuy]

Originally Posted by kieselguhr

OTC or not it’s still a medication that has potential for side effects. What if you’re on blood thinners and the physician has no idea. Congratulations, you now have a GI bleed, or worse. Of course you can go ahead and purchase them over the counter and use them on your own volition as I highly doubt you will sue yourself.


AOW

Well, no... My Urologist has my full medical record, for the last 15 years. I filled it out at least once a year and EVERY visit the assistant would ask me if there were any changes to my meds. They have a complete list, (actually, I only take one prescription regularly) they even wrote down which brand of vitamins I take and how often, plus fish oil etc. Now, if I LIED to them, then a lawsuit wouldn’t do me any good. It is still ridiculous.

[daveathall]

The waiting room at our local doctors surgery has brilliant magazines, some of the doctors there must be well into cars, as there are always many up to date car magazines. I find myself getting irritated if I get called for my appointment when I am half way through an article. Sometimes, afterwards, I will go back to the waiting room and finish reading.

[tritium8]

Originally Posted by Dubshack

Insurance companies need to be the ones to crack down. They’re the ones paying these phony fees. And we get stuck with higher premiums/deductibles/etc.

System is definitely flawed.


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Often (most) times they are the ones pulling the strings.

[Abdullah71601]

Originally Posted by TheVTCGuy

I’m with you. When my Diverticulitis was not responding to antibiotics last summer I was referred to a Gastro, SIX WEEKS was the first appointment. He wanted a colonoscopy; FOUR WEEKS for that. Keep in mind my life was a living hell. Then had to make an appointment to see the Gastro to go over the results of the oscopy. FOUR MORE WEEKS. He tells me it’s very bad and I need surgery. Thanks, three months of being miserable to be told I have to have part of my intestines removed.

How do we get compensated for the unnecessary stress and anxiety we endure while waiting for care?

For contrast, when I lived in Abu Dhabi my back went out. I couldn’t move or breath without excruciating pain. My wife managed to get me into the ER at a nearby hospital. Within two hours I had x-rays and an MRI. An hour later a neurologist saw me. The back specialist walked in while the neurologist was still in the room. A two minute convo and they had meds, treatment, and physio lined out for the next month. My cost - zero.

[Rolex addict]

Fortunately, I haven't really experienced any of the lengthy waits like some, but have had poor service. My recent hospital stay for one. All I can say is it's a testament to my activities landing me in doctor's offices many, many times. The ortho that came to see me in ICU was absolute shit. He spent literally less than 5 minutes with me because he knew I had an ortho group in Charlotte. I use OrthoCarolina in Charlotte and have for over 15 years. All I did was make a call and they had me in and I was put on the surgery schedule that afternoon. One week before the Ironman World Championships, I broke my finger. I called, explained the situation, and they had me in there the next day. I can promise you it's better to have to wait than have the relationship that gets you in THAT quickly.

[Chester01]

Originally Posted by superdog

I’ve been going to the same general practitioner for 15 years.

He was a home practice guy. Then got bought out by a big University hospital. He retired a few years later. But I liked the new guy so I stayed. I actually like him a lot.

That said, I get my meds refilled just like the rest of my PPO folks out there. Recently, my pharmacy would not refill my asthma or high blood pressure meds. They kept asking my doctor, but no response. They asked me to follow up.

When I did, I was told I had to come in. I said I would and asked that they call them in. They said no. Doctors orders. They had to see me before refilling my prescriptions.

I asked to speak to the doctor. They said he was busy. I had two choices, come in and get my meds or don’t and possibly die. I’m paraphrasing, but that was the gyst of it.

I asked if they were slow, and if they needed to generate revenue. They actually said yes. I stated I had a physical 7 months ago. They said, too bad.

I get there, and I was informed I needed blood work. I reiterated I was in 7 months ago. Non starter. Blood was taken.

Doctor comes in and I’m frank in my annoyance. He confirms his equal annoyance. Says he has the same conversation multiple times a weeks. And that he wants to leave.

Shady.

But they wanted the revenue. And they actually risked my health to get it. Clearly, I’m not the only one.

Shady.

Broken system.

What I can say is it is a complicated system and while profits are a clear motive for these big hospitals especially in NJ, so many mergers in the past 5 years. However, the visit necessity is also driven by malpractice issues. Folks on BP meds, diabetes meds, etc... while one can keep renewing over the phone, there is some rationale for keeping close tabs on meds response, patients follow-through with treatment recommendations, monitor side effects, and vitals.

I mean look at it from the other side, picture a patient, and doc in court. The patient sues the doc for some kind of issue. The judge says doc, have you examined the patient....well uh, sure, well how long ago, well 1 year ago....Judge-so let me get this straight you prescribed meds to treat the condition, but did not examine him/her in a year. Meanwhile the patient may be seeing other docs, getting other meds, and while the BP is perhaps in control or not or the patient is compliant or not, and also their blood sugar, A1C, etc. may also be trending up, what about kidney functions??? as some of these meds impact these things.... Its complicated.

[pickettt]

Originally Posted by Chester01

What I can say is it is a complicated system and while profits are a clear motive for these big hospitals especially in NJ, so many mergers in the past 5 years. However, the visit necessity is also driven by malpractice issues. Folks on BP meds, diabetes meds, etc... while one can keep renewing over the phone, there is some rationale for keeping close tabs on meds response, patients follow-through with treatment recommendations, monitor side effects, and vitals.

I mean look at it from the other side, picture a patient, and doc in court. The patient sues the doc for some kind of issue. The judge says doc, have you examined the patient....well uh, sure, well how long ago, well 1 year ago....Judge-so let me get this straight you prescribed meds to treat the condition, but did not examine him/her in a year. Meanwhile the patient may be seeing other docs, getting other meds, and while the BP is perhaps in control or not or the patient is compliant or not, and also their blood sugar, A1C, etc. may also be trending up, what about kidney functions??? as some of these meds impact these things.... Its complicated.

This is the issue 100%.

[JasoninDenver]

Originally Posted by pickettt

This is the issue 100%.

Except for the reality that malpractice claims rates, number of lawsuits and amounts paid have dropped dramatically over the last 20 years since many states have imposed tort reform laws that prevented many frivolous lawsuits.

Yet, while claims have declined, insurance premiums for doctors med mal coverage have increased. Just another example of insurance companies rigging the game as they do at the other end to cover the cost of health care.

[Knappo 1307]

Originally Posted by Chester01

What I can say is it is a complicated system and while profits are a clear motive for these big hospitals especially in NJ, so many mergers in the past 5 years. However, the visit necessity is also driven by malpractice issues. Folks on BP meds, diabetes meds, etc... while one can keep renewing over the phone, there is some rationale for keeping close tabs on meds response, patients follow-through with treatment recommendations, monitor side effects, and vitals.

I mean look at it from the other side, picture a patient, and doc in court. The patient sues the doc for some kind of issue. The judge says doc, have you examined the patient....well uh, sure, well how long ago, well 1 year ago....Judge-so let me get this straight you prescribed meds to treat the condition, but did not examine him/her in a year. Meanwhile the patient may be seeing other docs, getting other meds, and while the BP is perhaps in control or not or the patient is compliant or not, and also their blood sugar, A1C, etc. may also be trending up, what about kidney functions??? as some of these meds impact these things.... Its complicated.

This is the key here in this situation, I feel. No doctor or staff is going to approve any medicine for someone who has not physically seen them. Who knows if that patient has been elsewhere and was prescribed meds that could possibly interfere with the meds the patient wants rx'ed.

[Chester01]

Originally Posted by Knappo 1307

This is the key here in this situation, I feel. No doctor or staff is going to approve any medicine for someone who has not physically seen them. Who knows if that patient has been elsewhere and was prescribed meds that could possibly interfere with the meds the patient wants rx'ed.

I mean I am on the other side of things and get patients calling all the time asking for meds renewals over the phone and we know they are engaging in risky behaviors (I.e. missing doses, taking all kind of supplements/herbs, maybe even using alcohol, tobacco) and of course ones medical situation does not remain static. Of course many folks are compliant, but it means that docs have to be more diligent about examining the patient to make sure they remain appropriate for the meds based upon the data gathered in the exam. One slip, and medical professionals and clinic sued. The large hospitals and clinics are spending far more time managing risk and managing risk means keeping closer tabs on patients, but more $$ as well. Vicious cycle.


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[JasoninDenver]

Interesting discussion.

I am amazed that people still support our “free market” profit driven medical care model given that we are the only developed country in the world that still thinks this is the best way to do something.

I can understand many people’s sense that the market or capitalist system can produce the best results in many transactional systems. However, health care is far from true free market system. This would require that we have information of the costs of the care we need. We do not. How many of us have received a bill after the fact that stunned us?

A free market system would also mean we have the ability and time to choose between providers based on results and costs. In many medical situations this is simply not an option. A heart attack patient is not in a position to research and decide, which is what a free market driven system requires by definition, when they need emergent care.

Also, many geographic markets are hostage to one provider. They have no choice.

Health insurers are part of the problem. They have ZERO incentive to negotiate rates on our behalf. They negotiate rates on THEIR behalf. The providers then raise their charges and and billing items to increase the potential for higher reimbursement rates.

My last physical therapy appointment took 45 minutes for my excellent therapist to review my exercises and spend 10 minutes dry needling my quadriceps. If my sports chiropractor does it, I am charged $125 on a cash pay. Because I may need a knee MRI, I need to follow insurance requirements to do PT in network first. The PT clinic billed my carrier $1,200.00 for the same service my chiro does for $125!!!!!

The kicker is that my insurance only paid the PT clinic $200 for the visit.

My last MRI for a shoulder was billed at $3,750.00. The carrier paid $900. In other developed countries (such as Japan) a similar MRI can be had for under $500.

Where is the logic in this? If anyone can explain how these prices are set and what these services cost the provider to deliver, I would love to hear it.

Granted, the US system can and does deliver great care, but only if you can afford it. However, most developed countries have similar, or even better, health outcomes.

https://www.healthsystemtracker.org/...es/#item-start

The kicker is that these other countries ALL manage to post comparable results while spending dramatically LESS per capita on healthcare.

[Blansky]

The bottom line is simply this. There are X number of dollars in health care. People and companies pay into it and doctors and hospitals draw it out. Except there is a middle man and the middle man bleeds out 25 billion in profits in the US a year. Worldwide it's 40 billion.

That's 25 billion that could have gone to health care. And how do they get away with it, they bribe politicians through their lobby groups.

It's hard to make changes on anything when there are powerful lobby groups that control government policy.

[timedate]

Originally Posted by Blansky

The bottom line is simply this. There are X number of dollars in health care. People and companies pay into it and doctors and hospitals draw it out. Except there is a middle man and the middle man bleeds out 25 billion in profits in the US a year. Worldwide it's 40 billion.

That's 25 billion that could have gone to health care. And how do they get away with it, they bribe politicians through their lobby groups.

It's hard to make changes on anything when there are powerful lobby groups that control government policy.

you should see how our nhs gets shafted then, in so many ways,

i wont go into it as its political, but at one point they were being charged £40 to have a lightbulb changed by private contractors.

[Art 1]

Originally Posted by timedate

you should see how our nhs gets shafted then, in so many ways,

i wont go into it as its political, but at one point they were being charged £40 to have a lightbulb changed by private contractors.

Thing is, a company can't go and send a person out and change a light bulb for that price. They would go bankrupt. So don't blame the maintenance company. Blame the system for not have hourly people to do general maintenance.

Not picking on you, I get your point. The company that I own, HVAC, we would charge around $185 to go replace a light bulb, if it were easy, and the bulb was supplied. Being a hospital, plus parking fees.

[timedate]

Originally Posted by Art 1

Thing is, a company can't go and send a person out and change a light bulb for that price. They would go bankrupt. So don't blame the maintenance company. Blame the system for not have hourly people to do general maintenance.

Not picking on you, I get your point. The company that I own, HVAC, we would charge around $185 to go replace a light bulb, if it were easy, and the bulb was supplied. Being a hospital, plus parking fees.

this was just a minor example.

[encarter13]

Originally Posted by superdog

It’s a shame.

Truly, profits over patients. And taking advantage of the system.

This. Exactly this! Where I live in Northeast Georgia. The local hospital has been awarded #1 heart hospital in the state and is frequently mentioned in the top around the country. Well, the Heart Center Physicians have been renegotiating their contract for 2 years. Long story short, the hospital let them walk.

One of the hospitals in ATL welcomed them with open arms. They are even going to build a new heart center just for this group.

Some might think the doctors were being greedy, but I know several people related with the hospital and the negotiations. It was all about maximizing profits and the hospital thinking they were too big and powerful for the physicians to leave.

[Moggo]

Originally Posted by timedate

you should see how our nhs gets shafted then, in so many ways,



i wont go into it as its political, but at one point they were being charged £40 to have a lightbulb changed by private contractors.

That’s not being shafted, that’s poor decision making by our lovely government.

Nobody is accountable, spend your budget and just take more from the tax payers.

Nice work if you can get it

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[uscmatt99]

Originally Posted by JasoninDenver

Interesting discussion.

I am amazed that people still support our “free market” profit driven medical care model given that we are the only developed country in the world that still thinks this is the best way to do something.

I can understand many people’s sense that the market or capitalist system can produce the best results in many transactional systems. However, health care is far from true free market system. This would require that we have information of the costs of the care we need. We do not. How many of us have received a bill after the fact that stunned us?

A free market system would also mean we have the ability and time to choose between providers based on results and costs. In many medical situations this is simply not an option. A heart attack patient is not in a position to research and decide, which is what a free market driven system requires by definition, when they need emergent care.

Also, many geographic markets are hostage to one provider. They have no choice.

Health insurers are part of the problem. They have ZERO incentive to negotiate rates on our behalf. They negotiate rates on THEIR behalf. The providers then raise their charges and and billing items to increase the potential for higher reimbursement rates.

My last physical therapy appointment took 45 minutes for my excellent therapist to review my exercises and spend 10 minutes dry needling my quadriceps. If my sports chiropractor does it, I am charged $125 on a cash pay. Because I may need a knee MRI, I need to follow insurance requirements to do PT in network first. The PT clinic billed my carrier $1,200.00 for the same service my chiro does for $125!!!!!

The kicker is that my insurance only paid the PT clinic $200 for the visit.

My last MRI for a shoulder was billed at $3,750.00. The carrier paid $900. In other developed countries (such as Japan) a similar MRI can be had for under $500.

Where is the logic in this? If anyone can explain how these prices are set and what these services cost the provider to deliver, I would love to hear it.

Granted, the US system can and does deliver great care, but only if you can afford it. However, most developed countries have similar, or even better, health outcomes.

https://www.healthsystemtracker.org/...es/#item-start

The kicker is that these other countries ALL manage to post comparable results while spending dramatically LESS per capita on healthcare.

This is an excellent post. Patients often have no idea what they will owe until months after a service is rendered. Providers often have no idea what they will receive for services rendered until months down the road. Then both patients and providers are left to fight with insurance companies on the numbers, which vary widely for what is nominally the same service.

Imagine a system where you went and grabbed a box of cereal at the grocery store. A clerk writes down what you walked out with. Months later you get a bill for $40 for a $5 box of cereal. The cereal company and grocery store get $5. Where did the rest go? The people who employ the clerk....

[uscmatt99]

Originally Posted by encarter13

This. Exactly this! Where I live in Northeast Georgia. The local hospital has been awarded #1 heart hospital in the state and is frequently mentioned in the top around the country. Well, the Heart Center Physicians have been renegotiating their contract for 2 years. Long story short, the hospital let them walk.

One of the hospitals in ATL welcomed them with open arms. They are even going to build a new heart center just for this group.

Some might think the doctors were being greedy, but I know several people related with the hospital and the negotiations. It was all about maximizing profits and the hospital thinking they were too big and powerful for the physicians to leave.

This is also a great point. Physicians have very little leverage in most negotiations with hospitals and insurance companies, other than scarcity and the willingness to walk away.