Doctors of VN

[508mikey]

Nope, self employed. That's how much health premiums went up. I was offered an individual plan from BCBS for $617 a month which covers ZERO medications.

Walmart has alot of generic drugs for 4 dollars and no ins needed -- they even show a list of them on the website, so there is no guessing like at CVS Walgreens etc -- btw did the salesman that offered that policy also try to sell you some prime real estate in South Detroit ?

 

[kiddiedoc]

Nope, self employed. That's how much health premiums went up. I was offered an individual plan from BCBS for $617 a month which covers ZERO medications.

I'm guessing that is a OCare compliant plan? Our family premium was going to be around $1400/month if we went that route. Instead, we rolled the dice with a "noncompliant" plan, and Trump looks to have taken care of that situation.

 

[Coug]

Walmart has alot of generic drugs for 4 dollars and no ins needed -- they even show a list of them on the website, so there is no guessing like at CVS Walgreens etc -- btw did the salesman that offered that policy also try to sell you some prime real estate in South Detroit ?

I've slowly managed to get all meds down to generics the past couple years. There are no real choices or exceptions with individual plans.

I'm guessing that is a OCare compliant plan? Our family premium was going to be around $1400/month if we went that route. Instead, we rolled the dice with a "noncompliant" plan, and Trump looks to have taken care of that situation.

Yup. There was a "gold" plan above mine that was over $1000 a month and even it didn't cover ANY prescriptions. Why would anyone pay $7400+ a year for health insurance or God forbid $12000 a year?

 

[BEATBAMA12]

I had to leave my dream job last year for a company with better health insurance , for a family of 4 I would have paid over 1200$/ month, now I pay 575$/ month at my current company. And premiums going up 100$ starting Jan 1st.

Ocare is horrible

 

[Coug]

I had to leave my dream job last year for a company with better health insurance , for a family of 4 I would have paid over 1200$/ month, now I pay 575$/ month at my current company. And premiums going up 100$ starting Jan 1st.

Ocare is horrible

The government needs to get the hell out of health care.

 

[Thunder Good-Oil]

The government needs to get the hell out of health care.

I wish that the government would either take it over or get out of the way. The current system isn't working. Maybe if Walmart, Walgreens, and CVS were allowed to expand their health care offerings it would get better.

 

[BEATBAMA12]

I don’t go to the dr often, basically only my kids go, the few times I did go it was to an urgent care clinic, 60$ copay, for a RNP to give me a strep/ flu test, 20$ copay if I go to family physicians, but I couldn’t have gotten seen until today when I was sick last Tuesday.

I’ll soon be paying almost 700$/ month for healthcare for 4 pretty healthy people, non smokers/ drinkers, not obese, only major health concern was my cornea repair surgery 10 years ago and my tonsillectomy 3 years ago.

These premiums aren’t helping my family at all.

 

[kiddiedoc]

Maybe if Walmart, Walgreens, and CVS were allowed to expand their health care offerings it would get better.

Explain please. I'm hoping that you aren't referring to retail-based clinics, as these are consistently the worst medicine I see (and a conflict of interest, at their very nature).

 

[Thunder Good-Oil]

I don't know who's to blame... big Pharma, big insurance, the AMA, lawyers, the government, bad personal choices by the patients, bad business decisions by practitioners... all of the above? But healthcare costs are out of control... something like $10,000 per person per year. At least O'Bama tried to fix it... unfortunately he seems to have made it even worse.

 

[Thunder Good-Oil]

Explain please. I'm hoping that you aren't referring to retail-based clinics, as these are consistently the worst medicine I see (and a conflict of interest, at their very nature).

Lack of competition is an issue. But the clinics might be picking off the most lucrative parts only and staying away from the loss leaders. That's creating a case for the government to intervene... which is rarely an efficient solution. Somebody needs to figure out how to get costs under control.

 

[kiddiedoc]

Lack of competition is an issue. But the clinics might be picking off the most lucrative parts only and staying away from the loss leaders. That's creating a case for the government to intervene... which is rarely an efficient solution. Somebody needs to figure out how to get costs under control.

From an insider's perspective, I can tell you that retail-based clinics are notorious for over-prescribing (which, of course, benefits the pharmacy counter 20 feet away) and mismanaging or misdiagnosing even common problems. This then drives up costs as patients end up needing another visit with their primary care provider or hospital ER. Also, the effects of antibiotic and steroid overuse are well-documented. I see this crap all the time.

And, God help you if you need to discuss something with the supervising Physician, who might be on a golf course in Nashville.

 

[508mikey]

Explain please. I'm hoping that you aren't referring to retail-based clinics, as these are consistently the worst medicine I see (and a conflict of interest, at their very nature).

Youre right - I was going to get a quick flu shot at Walgreens and the clowns wanted me to fill out a 3 page form (of course listing my address, dob and other things at least 3 times on the same form -- really ?) -- said screw it and went to the Dr office

 

[508mikey]

I don't know who's to blame... big Pharma, big insurance, the AMA, lawyers, the government, bad personal choices by the patients, bad business decisions by practitioners... all of the above? But healthcare costs are out of control... something like $10,000 per person per year. At least O'Bama tried to fix it... unfortunately he seems to have made it even worse.

you left out hospital adm pay -- a CEO makes well over 2 million

 

[Thunder Good-Oil]

From an insider's perspective, I can tell you that retail-based clinics are notorious for over-prescribing (which, of course, benefits the pharmacy counter 20 feet away) and mismanaging or misdiagnosing even common problems. This then drives up costs as patients end up needing another visit with their primary care provider or hospital ER. Also, the effects of antibiotic and steroid overuse are well-documented. I see this crap all the time.

And, God help you if you need to discuss something with the supervising Physician, who might be on a golf course in Nashville.

If Walmart was allowed to run actual medical offices instead of just tiny clinics it would be a different story. The cost of optometry and opticians went way down when companies were allowed to compete. If Walmart had an army of physicians and PAs on their payroll, they're not all going to be out playing golf. I've received prescriptions in emergency rooms but the hospital didn't require that it be filled exclusively by their in-house pharmacy.

I've been to a non-retail based medical office and their procedure on every visit was to immediately take X-rays. Funny how that kidney stone that they thought they were monitoring started moving BACKWARDS. But the office has to pay for that X-Ray machine and the technician's salary that runs it... plus the rent on the square footage for the space. But come on back in 3 weeks and we'll do it all over again.

 

[kiddiedoc]

That sounds like a bad experience -- I hope you have found a new provider that you trust.

Nothing, and I mean NOTHING, will convince me that expanding retail-based clinics is a good idea. I could fill a novel with crappy care stories I've witnessed over the past 14 years. I'm certain that every friend/colleague of mine will tell you the same, and the American Academy of Pediatrics has issued multiple policy statements opposing RBCs.

 

[Thunder Good-Oil]

That sounds like a bad experience -- I hope you have found a new provider that you trust.

Nothing, and I mean NOTHING, will convince me that expanding retail-based clinics is a good idea. I could fill a novel with crappy care stories I've witnessed over the past 14 years. I'm certain that every friend/colleague of mine will tell you the same, and the American Academy of Pediatrics has issued multiple policy statements opposing RBCs.

I think that a better track is not to expand existing clinics but to instead transform the entire system. I only mention Walmart, CVS, and Walgreens because they currently offer an alternative to the traditional, inefficient system. I think that well capitalized entities could step into the space and stimulate the creation of a game changing system. The current players are comfortable with the status quo. They're doing well financially while the "customers" are often filtered through the system like cattle and have to deal with backlogs of weeks or even months.

Maybe there needs to be a two-tiered system... like airlines offering first class. Let a Walmart type of operation shuffle us common fellers through a mega triage facility. Utilize efficiency and scale. Then let those rich folk that want special treatment buy their access to boutique-style clinics. I guess basically let the "Walmarts" run no frills hospital/clinic operations. Get the insurance company and Pharma execs and sales forces further out of the process. And the lawyers too. Even involve the government to some degree... oversight to minimize abusive practices, consolidate data, being resources to difficult and rare cases, legislate the lawyers out of the system.

It's just a fantasy. The Pharma, insurance, hospital, legal, AMA, etc. lobbies would prevent any type of health care revolution. I'm sure that I'll have to keep filling out the same redundant paperwork and be shuffled from room to room in offices for years to come any time that I have to seek treatment for any sniffle or boo-boo.

 

[kiddiedoc]

I think that a better track is not to expand existing clinics but to instead transform the entire system. I only mention Walmart, CVS, and Walgreens because they currently offer an alternative to the traditional, inefficient system. I think that well capitalized entities could step into the space and stimulate the creation of a game changing system. The current players are comfortable with the status quo. They're doing well financially while the "customers" are often filtered through the system like cattle and have to deal with backlogs of weeks or even months.

Maybe there needs to be a two-tiered system... like airlines offering first class. Let a Walmart type of operation shuffle us common fellers through a mega triage facility. Utilize efficiency and scale. Then let those rich folk that want special treatment buy their access to boutique-style clinics. I guess basically let the "Walmarts" run no frills hospital/clinic operations. Get the insurance company and Pharma execs and sales forces further out of the process. And the lawyers too. Even involve the government to some degree... oversight to minimize abusive practices, consolidate data, being resources to difficult and rare cases, legislate the lawyers out of the system.

It's just a fantasy. The Pharma, insurance, hospital, legal, AMA, etc. lobbies would prevent any type of health care revolution. I'm sure that I'll have to keep filling out the same redundant paperwork and be shuffled from room to room in offices for years to come any time that I have to seek treatment for any sniffle or boo-boo.

Man, you are one jaded SOB

Getting "healthcare" at a pharmacy clinic or Wal-Mart is like "eating" at Krystal or McDonalds. It might be fast and cheap, but it's most likely NOT what your body needs.

Believe it or not, there is a benefit to seeing an actual doctor who is knowledgeable in microbiology/immunology, pharmacology, and physiology, as well as experienced in the rare but not always apparent serious conditions that might not be recognized a lesser-trained RBC practitioner.

I don't mean that to sound haughty or condescending, but I could give you a long list of crazy stuff I have diagnosed over the years at strange times. Example: I saw a kid years ago that had bounced around walk in clinics, NPs, etc for an initial ADHD visit. I always take time to do a full exam on new pts and found a very concerning heart murmur between his shoulder blades. He had open heart surgery two days later for a critical aortic coarctation. God knows how many times people had "listened" to him and missed that murmur, but he was literally one heavy strain from a possible fatal CV event.

That's obviously an extreme example, but every week I see inappropriate antibiotic selections, mismanagement of routine viral infections, misdiagnosed derm conditions, etc from RBCs and other "walk-in" clinics or community hospital ERs not staffed by board-certified Pediatricians. It's also a pain in the ass to explain to parents that their kids don't need a steroid shot and antibiotic for every affliction, even though that's what the parent gets when they visit this type of practice.

It does take effort to stay current with research, treatment modalities, etc, but that's just what we do at my office.

 

[Thunder Good-Oil]

Man, you are one jaded SOB

Getting "healthcare" at a pharmacy clinic or Wal-Mart is like "eating" at Krystal or McDonalds. It might be fast and cheap, but it's most likely NOT what your body needs.

Believe it or not, there is a benefit to seeing an actual doctor who is knowledgeable in microbiology/immunology, pharmacology, and physiology, as well as experienced in the rare but not always apparent serious conditions that might not be recognized a lesser-trained RBC practitioner.

I don't mean that to sound haughty or condescending, but I could give you a long list of crazy stuff I have diagnosed over the years at strange times. Example: I saw a kid years ago that had bounced around walk in clinics, NPs, etc for an initial ADHD visit. I always take time to do a full exam on new pts and found a very concerning heart murmur between his shoulder blades. He had open heart surgery two days later for a critical aortic coarctation. God knows how many times people had "listened" to him and missed that murmur, but he was literally one heavy strain from a possible fatal CV event.

That's obviously an extreme example, but every week I see inappropriate antibiotic selections, mismanagement of routine viral infections, misdiagnosed derm conditions, etc from RBCs and other "walk-in" clinics or community hospital ERs not staffed by board-certified Pediatricians. It's also a pain in the ass to explain to parents that their kids don't need a steroid shot and antibiotic for every affliction, even though that's what the parent gets when they visit this type of practice.

It does take effort to stay current with research, treatment modalities, etc, but that's just what we do at my office.

I just think that it's a whack system that is badly in need of some type of massive reform. Put those actual doctors who are knowledgeable in microbiology/immunology, pharmacology, and physiology, as well as experienced in the rare but not always apparent serious conditions on the Walmart Super Clinic payroll. Don't let the most talented diagnostician's time be monopolized with the trivial and routine.

I actually would put a large degree of blame on the "customers". I believe that there exists a significant portion of the population that avoids healthcare due to the extreme inconvenience. Due to insurance and legal issues, even the obvious hypochondriacs are allowed to clog up the system.

Another issue that I have with the "customer" is how so many try to get back more than they pay in. Everything beyond the maximum out of pocket is "free". Employee plans don't extract the problem patients from the system. Few "customers" care what anything will cost if they hit their OOP limits every year.

Another peeve that has me jaded about the health care "business" is the pricing system. The insurance companies are probably the problem behind that. The cost of drugs, procedures, supplies, and other stuff is all over the place. I wish that true competition could drive prices instead of overpaid "suits" negotiating their pricing schedules... and it's kept out of view of the patient/customers. It's a broken system for the masses... not necessarily to those making a comfortable living off of it though.

 

[Thunder Good-Oil]

BTW, my back hurts and my right eye often stings where I had refraction surgery 15 years ago. And my hair follicles seem to be migrating to other areas on my body. Is there a pill that I can take for this stuff?

 

[kiddiedoc]

Put those actual doctors who are knowledgeable in microbiology/immunology, pharmacology, and physiology, as well as experienced in the rare but not always apparent serious conditions on the Walmart Super Clinic payroll. Don't let the most talented diagnostician's time be monopolized with the trivial and routine.

I'd rather not make $15/hr, but thanks. And you can't predict who or when a serious problem will present.

There's no easy solution, but I can say with certainty that this isn't the way.

 

[Thunder Good-Oil]

I'd rather not make $15/hr, but thanks. And you can't predict who or when a serious problem will present.

There's no easy solution, but I can say with certainty that this isn't the way.

Competition makes things better for consumers. There is very little of that in the current model. "Walmart" Super Clinics would bring it... it would be disruptive though to the existing practice owners.

In addition to competition, technological advancements should thrive as well. Put the doctors several layers behind initial evaluations instead of wasting a lot of their time on the front end. Before I even set foot in a medical facility I should be able to input my symptoms into an app that feeds the data into an algorithm that processes likely conditions and then the $15/hour trained staff should be ready to take my temp, BP, HR, etc. and then direct me to the next step. Instead it's show the lady at the desk my piece of paper from the insurance company, take this clip board full of paper forms, fill them out, go sit down and wait, be exposed to god knows what, get your name called, see the guys taking the BP, HR, temp... go to another room. Wait. Get a visit from the doc. Have him/her order a bunch of stuff (that might cost a small fortune... but when I ask how much they get snippy), maybe give some blood and piss, go back. Wait. Get a best guess diagnosis. Rinse. Repeat at a future appointment. Sadly, it's lacking in innovation.

BTW... it's the greeters making $15/hour at Walmart. The professional staff makes considerably more.

 

[volsarelife1]

Kiddiedoc, I feel like you would agree with this. I think one problem with these clinics is the over use of prescribing antibiotics. (This is both a "customer" issue and some of these clinics. You have a person coming in demanding they want something to feel better.

I'm just a nurse so of course I don't know that much on the physiology, immunology, and micro portions, but of what I know about antibiotic resistance and the over prescribing, I feel like that's why it seems like illnesses are lasting longer and longer, and being stronger. You don't need that antibiotic for every little thing, actually will make things worse for not only you, but others as well.

I remember that being something my nursing instructor preached to us about, was antibiotic resistance and the problems it's causing.

 

[kiddiedoc]

Before I even set foot in a medical facility I should be able to input my symptoms into an app that feeds the data into an algorithm that processes likely conditions...

I'm hoping you aren't serious.

A recent example of how stupid this is: saw a kid with an earache this week who decided to start some leftover antibiotics at home (gasp). Your algorithm might have missed the deep neck space abscess that he is now being treated for with IV antibiotics and likely surgical intervention.

 

[kiddiedoc]

Kiddiedoc, I feel like you would agree with this. I think one problem with these clinics is the over use of prescribing antibiotics. (This is both a "customer" issue and some of these clinics. You have a person coming in demanding they want something to feel better.

I'm just a nurse so of course I don't know that much on the physiology, immunology, and micro portions, but of what I know about antibiotic resistance and the over prescribing, I feel like that's why it seems like illnesses are lasting longer and longer, and being stronger. You don't need that antibiotic for every little thing, actually will make things worse for not only you, but others as well.

I remember that being something my nursing instructor preached to us about, was antibiotic resistance and the problems it's causing.

That's pretty much spot on

 

[kiddiedoc]

TGO, one note on inefficiency:

Establishing a "medical home" or primary care provider should help immensely, if the practice is run well. New patients always have some paperwork/data entry, history taking, med history etc, but that's important information if handled correctly.

Once the up-front legwork is done, a good EMR should streamline the check in and history process. Example: my patients this morning have spent an average of 23.4 minutes in the office, from door to door.

If you are bouncing around from ERs to walk in clinics, etc, the time burden is your own fault.