healthcare in the US

[blackribbon]

FYI: I had two patients (well 3 if you count the newborn) in my care last night. They were on opposite sides of the unit. I had to do hourly checks on both of them which took anywhere from 3 minutes to 20min. I walked 3 miles on last night shift walking back and forth between the two room.

I love my job but I can't say that I don't try to come up with job that would take me out of the hospital

 

[cow451]

We treat them if they need to be treated. We give them the same care and compassion as everyone else. I know for a fact that many of my patients don't have insurance or a way to pay because they have told me...and when you know they are homeless with no job, you also have a pretty good idea.

At my previous hospital (much smaller), the doctors would write orders to not discharge until after supper was served to make sure the homeless patients got one more meal before they walked. And I know the nurses at that hospital would pool our money to pay for a taxi to get certain patients to a place they could go and be safe but was too far to walk.

I already figured the quality of care would not differ. I was really asking how do these services get paid? How should they be paid for. None of you are working for free.

 

[bhsmte]

But doesn't that system just drive up the cost for everybody else? I'm not saying don't treat them, but the hospital will cover that shortfall somewhere else and eventually you get to the system we have now where a doctor sticking their head in to ask if you are feeling alright ends up as a 100 dollar charge on a bill.

It does drive up costs.

The other thing it does, is keep people away from seeking care (because they don't have coverage), until they are so bad, they have to go to a hospital. Many health issues are reduced or even prevented, if people had access to adequate care.

 

[blackribbon]

But doesn't that system just drive up the cost for everybody else? I'm not saying don't treat them, but the hospital will cover that shortfall somewhere else and eventually you get to the system we have now where a doctor sticking their head in to ask if you are feeling alright ends up as a 100 dollar charge on a bill.

It is already happening. People who need medical care get it...regardless of ability to pay. Our healthcare system before Obamacare provided health care to the indigent...people who needed treatments could find those treatments. And the high cost is really related to Medicare reimbursements making the hospital jack up their prices so that they can make sure that Medicare patients are paying for at least most of their care. And $100 isn't even an excessive charge because you are paying for their knowledge and experience that took 4 years of college, 3 years of medical school, and 3 years of residency...to acquire. They also may look things up and they have to chart what they did too...often the charting and research take more time than the patient visit.

 

[LoAmmi]

It is already happening. People who need medical care get it...regardless of ability to pay. Our healthcare system before Obamacare provided health care to the indigent...people who needed treatments could find those treatments. And the high cost is really related to Medicare reimbursements making the hospital jack up their prices so that they can make sure that Medicare patients are paying for at least most of their care. And $100 isn't even an excessive charge because you are paying for their knowledge and experience that took 4 years of college, 3 years of medical school, and 3 years of residency...to acquire. They also may look things up and they have to chart what they did too...often the charting and research take more time than the patient visit.

Let me tell you a story about the 100 dollars. My then girlfriend was in a bad accident and broke her femur. She had surgery and I was with her as much as I could. I knew who her doctors were and all that. One day, this guy sticks his head in the room, says "She doing alright?" and I say she seems to be sleeping fine. He walks away. Later, this guy got a charge on her bill. Now, there's nothing he did in that instant that has anything to do with his years of college. The other doctors that talked to her and did things for her? Absolutely and they deserved to be paid. Asking me if the patient is doing alright? That's relying more on my expertise than his!

 

[blackribbon]

I already figured the quality of care would not differ. I was really asking how do these services get paid? How should they be paid for. None of you are working for free.

They are getting paid. My hospital is far from having financial issues. The problem is the complicated insurance reimbursement system. The hospital seldom gets paid what the price on the bill is but each insurance company has negotiated to pay pennies on the dollars.

If the reimbursements had to actually be inline with the value of actual services and Medicare wasn't allowed to discount their rates, I think we would have a better healthcub system

 

[blackribbon]

Let me tell you a story about the 100 dollars. My then girlfriend was in a bad accident and broke her femur. She had surgery and I was with her as much as I could. I knew who her doctors were and all that. One day, this guy sticks his head in the room, says "She doing alright?" and I say she seems to be sleeping fine. He walks away. Later, this guy got a charge on her bill. Now, there's nothing he did in that instant that has anything to do with his years of college. The other doctors that talked to her and did things for her? Absolutely and they deserved to be paid. Asking me if the patient is doing alright? That's relying more on my expertise than his!

So you dispute that bill and don't pay it. Same as when you don't get the service you contract for in the rest of the world.

 

[blackribbon]

But doesn't that system just drive up the cost for everybody else? I'm not saying don't treat them, but the hospital will cover that shortfall somewhere else and eventually you get to the system we have now where a doctor sticking their head in to ask if you are feeling alright ends up as a 100 dollar charge on a bill.

It isn't any difference that if everyone is forced to pay up front for care they may or may not need like would be happening in a universal healthcare system. You pay the taxes before needing any medical service. The richer people pay more because they earn more. The poorest pay nothing into the system And when poor person collecst on services that he didn't pay for via taxes, it drives up the rates on the richer people have to make up the difference.

The only difference is who is managing the money...

 

[dogs4thewin]

We can't even keep RNs right now. They expect too much of us and the stress is extraordinary. Going to a universal health care system would make our job harder....less money would be available which means management won't staff the hospital and we will be working with less supplies.

my point was they need to make being an RN MORE appealing ( which would include less stressful.

 

[cow451]

They are getting paid. My hospital is far from having financial issues. The problem is the complicated insurance reimbursement system. The hospital seldom gets paid what the price on the bill is but each insurance company has negotiated to pay pennies on the dollars.

If the reimbursements had to actually be inline with the value of actual services and Medicare wasn't allowed to discount their rates, I think we would have a better healthcub system

Now you don’t object to my insurance helping pay for something I’m not getting? How is that different from requiring people to have insurance covering something they don’t plan on using?

 

[blackribbon]

my point was they need to make being an RN MORE appealing ( which would include less stressful.

The only thing that is going to do that is to put MORE money into the system so that we can be staffed better. Do you think any sort or universal plan or single player plan would do that? They won't be able to afford it. This is where that "evil" word profit comes in...you have to make money to be able to pay your RNs (and hire enough to be properly staffed). We get no incentives and I'd be afraid of a hospital that offered them...."what is wrong with this hospital that they have to bribe people to be on their staff".

 

[dogs4thewin]

What, if anything, should be done about the uninsured patients that your facility treats?

What about having a lean on their property you can not pay you cannot sell your property until you can. If they have NOTHING then you can either write it off or require them to set up a payment plan. For example, when my father died they wrote off the bill ( though we were willing to pay, but his was the name listed so they did not require us to do so. HOWEVER, the car that was in both of my parents' names mother could NOT sell unless and until she paid off that bill to the penny. In that case, of course otherwise they would reprocess the car which would not look good if she ever needed more credit for whatever reason.

 

[blackribbon]

Now you don’t object to my insurance helping pay for something I’m not getting? How is that different from requiring people to have insurance covering something they don’t plan on using?

No, I think you should dispute the bill.

However, if your insurance actually pays this bill, the doctor isn't getting anywhere near $100...he might get $30 based on the insurance company's contracted discounted contract, if he is lucky.

 

[dogs4thewin]

Now you don’t object to my insurance helping pay for something I’m not getting? How is that different from requiring people to have insurance covering something they don’t plan on using?

People can pick what they want covered verse having a list of things that the government says MUST be covered.

 

[dogs4thewin]

No, I think you should dispute the bill.

However, if your insurance actually pays this bill, the doctor isn't getting anywhere near $100...he might get $30 based on the insurance company's contracted discounted contract, if he is lucky.

Which is a major reason that many places will not take government heath care ( especially MEDICAID because the pay outs are such that frankly it is not worth it.

 

[blackribbon]

What about having a lean on their property you can not pay you cannot sell your property until you can. If they have NOTHING then you can either write it off or require them to set up a payment plan. For example, when my father died they wrote off the bill ( though we were willing to pay, but his was the name listed so they did not require us to do so. HOWEVER, the car that was in both of my parents' names mother could NOT sell unless and until she paid off that bill to the penny. In that case of course otherwise they would reprocess the car which would not look good if she ever needed more credit for whatever reason.

That is the law here in the US. We can't owe for someone else's debt after they die. However, since your mother was alive and a joint owner of the car, she still owed for entire debt that she entered into jointly with your father. The hospital could have made a claim on his personal property but hospitals are not usually in the business of ruining people. Your mother most likely never signed as a guarantor of your father's medical debt. They can only go after the one who promised to pay.

 

[blackribbon]

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[cow451]

No, I think you should dispute the bill.

However, if your insurance actually pays this bill, the doctor isn't getting anywhere near $100...he might get $30 based on the insurance company's contracted discounted contract, if he is lucky.

I think you’re replying to someone else’s post.

 

[cow451]

What about having a lean on their property you can not pay you cannot sell your property until you can. If they have NOTHING then you can either write it off or require them to set up a payment plan. For example, when my father died they wrote off the bill ( though we were willing to pay, but his was the name listed so they did not require us to do so. HOWEVER, the car that was in both of my parents' names mother could NOT sell unless and until she paid off that bill to the penny. In that case, of course otherwise they would reprocess the car which would not look good if she ever needed more credit for whatever reason.

Po’ folk got no property. Let me spell it out . Indigent care is paid by “cost shifting”. That means we that have insurance help pay for those that don’t. We share the cost.
What Is Cost Shifting?

 

[Radagast]

The only thing that is going to do that is to put MORE money into the system so that we can be staffed better. Do you think any sort or universal plan or single player plan would do that? They won't be able to afford it. This is where that "evil" word profit comes in...you have to make money to be able to pay your RNs (and hire enough to be properly staffed). We get no incentives and I'd be afraid of a hospital that offered them...."what is wrong with this hospital that they have to bribe people to be on their staff".

"Profit" refers to money that goes to the shareholders, not money used to pay the RNs.