Except that the emergency department brings in patients that will then need imaging and surgical services. So even though it may not be profitable on its own, the ED drives revenue to the hospital.
That is only true for patients who are able to pay. A significant portion of people seen in the ER do not have coverage and never end up paying for the visit.
Yes, but then I have 12 months of future medical expenses that may eclipse my deductible. In December, I have 12 months of prior medical expenses that definitely don’t eclipse my deductible.
My experience was that I had an expensive December test, then the next year an expensive September surgery, and I got to pay out the deductible both times. I realized that if I had delayed the test, I would have saved quite a bit of money, despite using the exact same medical services.
Around here (DC suburbs) some doctors manage the higher income by going to a concierge model - where you pay a fee to be included on their patient rolls. That fee does NOT pay for any of the healthcare you receive; office visits etc. are billed through to your insurance just like any other practice.
A typical doctor doing this will limit his/her patient lit to 1,000 patients. If the annual fee is 1,500, that’s 1.5 million dollars a year. Some of which goes to the sponsoring organization (MD-VIP is one around here), but still it’s a nice bit of additional income.
For this: the doctor has more time to spend with patients. The patient typically has faster access to a doctor (same-day appointments etc…) and I’ve heard rumors that some concierge doctors will even do house calls on occasion. The patient supposedly gets more individualized attention - when my previous internist went concierge, he used that as an argument for why it would be a good idea for me, given that I have a fairly long list of chronic conditions.
I declined the privilege.
But in any case, the doctors are going this route where we are because a) there are enough affluent people hereabouts to support this, and b) it lets them spend more time with their patients. They may only get that 60 bucks, but that’s on top of the 1500/patient annual fee.
To be honest, I don’t see how medical practices make it when that’s all they can bill. Not just the doctor’s income, but all the necessary (nurses, receptionists) and unnecessary (insurance wranglers) staff, rent, other overhead… And people in the US tend to go to specialists for anything, if they can (witness my ortho tale, above, though I do try to run stuff through primary care in general).
I think some concierge doctors don’t deal with insurance companies, by which I mean they’ll treat you and if you can get compensation from your insurance, great, but they’re not going to submit a bill. I’ve read someplace that 20% of the provider’s costs are related to getting payment from insurance companies.
Concierge medical practices generally are marketed toward wealthier people and include an upfront (decent sized) fee to join the service and a monthly maintenance fee. Some services are covered as just part of that fee itself, so it’s almost like a single-practice form of insurance. Most of the ones I’m familiar with will still submit claims for covered services, but concierge medical practices frequently do things that aren’t covered by insurance and they don’t submit claims for those.
There are different types of concierge practices - some don’t deal with insurance at all, some accept insurance plans and bill all the healthcare to the insurance and others don’t participate in any insurance plans and expect payment from the patient but will submit claims for the patient to be reimbursed.
Yes, none of the docs I have met are big fans of the AMA. You pay the dues to get the journal, and for the discount on the CPT books although I’m not sure if they even have that any more. Although it is not all criticism, our doc for example gave AMA lobbying partial credit for the COVID-19 provider relief fund.
~Max
If we did have something like, “Medicare for all who want it”, I’m sure that government would regulate the prices they paid down.
BTW, in case anyone else is like me; I didn’t realize until some years ago that the AMA does not represent all doctors; only a fraction are members. (In the same way, the American Bar Association does not represent all lawyers, and being a member of the bar and being a member of the ABA are not the same thing.)
I’m not sure they’d have to regulate it, they’d have tremendous purchasing power. It would be good, since downward pressure on prices would mean upward pressure on efficiency. That’s the way to reduce the ridiculous amounts paid for healthcare in the US as many have mentioned.
Unless, of course, they were barred from wielding that purchasing power:
Under the Part D program, private prescription drug plans (PDPs) provide drug coverage to Medicare enrollees. PDPs negotiate drug rebates and other discounts with pharmaceutical manufacturers, which reduce program costs and allow plans to compete for beneficiaries based on lowering premiums and patient out-of-pocket costs. However, the federal government is prohibited from negotiating drug prices in the Part D program as part of the Social Security Act’s noninterference clause. The clause states that the Department of Health and Human Services “may not interfere with the negotiations between drug manufacturers and pharmacies and PDP sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered part D drugs.”
But … back on my high horse … the two countries (US and New Zealand) in the world that do allow Direct To Consumer (DTC) advertising of prescription drugs [wait for it] have higher rates of “pills per adult” than any other advanced economy country (click on it to view it):
Broken. Just … broken.
Yeah, U.S. Medicare is famously barred from negotiating drug prices. Part of the compromise that got Part D passed at all, in the Bush years.
~Max