Why people are afraid of universal health care

[Terrell]

Some of the people that will benefit from it are people that some who oppose it don't like.

 

[Toni]

People scrub out of surgery all the goddamn time for all sorts of reasons.

I mean, my last job was at a company that made a surgical tool.

I imagine most idiots would be suitably shocked, though, at the kind of shit that happens with surgeons, doctors, and bureaucracy.

At any rate, I will attribute this all to someone failing to actually read the text in front of them: nothing about what the surgeon said said anything about having opened the patient. The patient was "asleep and on the table".

Note that it's still mid-surgery once the patient is asleep, even before they are cut upon, because that is part of the whole event of the surgery. The doctor is "in" the surgery as soon as they are scrubbed, and in theater.

Time under anesthesia is important. It potentially has major repercussions for the patient. Time booked into an OR is expensive.

 

[Jarhyn]

People scrub out of surgery all the goddamn time for all sorts of reasons.

I mean, my last job was at a company that made a surgical tool.

I imagine most idiots would be suitably shocked, though, at the kind of shit that happens with surgeons, doctors, and bureaucracy.

At any rate, I will attribute this all to someone failing to actually read the text in front of them: nothing about what the surgeon said said anything about having opened the patient. The patient was "asleep and on the table".

Note that it's still mid-surgery once the patient is asleep, even before they are cut upon, because that is part of the whole event of the surgery. The doctor is "in" the surgery as soon as they are scrubbed, and in theater.

Time under anesthesia is important. It potentially has major repercussions for the patient. Time booked into an OR is expensive.

All true. It still happens though, and I'm not going to doubt that it happened, especially since it was a post-cancer reconstruction.

It's still bad but definitely not unheard of. My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

In a small private practice doing breast reconstruction, I can imagine a lot more doctor involvement, too, in the financial process.

 

[Toni]

People scrub out of surgery all the goddamn time for all sorts of reasons.

I mean, my last job was at a company that made a surgical tool.

I imagine most idiots would be suitably shocked, though, at the kind of shit that happens with surgeons, doctors, and bureaucracy.

At any rate, I will attribute this all to someone failing to actually read the text in front of them: nothing about what the surgeon said said anything about having opened the patient. The patient was "asleep and on the table".

Note that it's still mid-surgery once the patient is asleep, even before they are cut upon, because that is part of the whole event of the surgery. The doctor is "in" the surgery as soon as they are scrubbed, and in theater.

Time under anesthesia is important. It potentially has major repercussions for the patient. Time booked into an OR is expensive.

All true. It still happens though, and I'm not going to doubt that it happened, especially since it was a post-cancer reconstruction.

It's still bad but definitely not unheard of. My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

In a small private practice doing breast reconstruction, I can imagine a lot more doctor involvement, too, in the financial process.

I'm sure this has happened. I've just never had a circumstance where non-emergency surgeries were NOT pre-authorized before the patient even arrived for surgery.

 

[Emily Lake]

My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

Fantastic way for hospitals to pad their bill while not actually providing more benefit or treatment to the patient. Never mind that it increases risk to the patient... it's more cash for the hospital's bottom line.

 

[ZiprHead]

My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

Fantastic way for hospitals to pad their bill while not actually providing more benefit or treatment to the patient. Never mind that it increases risk to the patient... it's more cash for the hospital's bottom line.

Why do you think they would charge more?

Medical reimbursement is based on diagnosis and procedure, not time.

 

[Elixir]

Medical reimbursement is based on diagnosis and procedure, not time.

Not strictly true. Many “visiting” specialists/surgeons are contracted here, but at least some of their anesthesiologists’ time and pay are only figured after the fact. What bugs me is that they don’t disclose costs upfront, at least the costs for the theater, surgeon etc. that are known. It’s pretty obscene.

 

[Emily Lake]

My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

Fantastic way for hospitals to pad their bill while not actually providing more benefit or treatment to the patient. Never mind that it increases risk to the patient... it's more cash for the hospital's bottom line.

Why do you think they would charge more?

Medical reimbursement is based on diagnosis and procedure, not time.

Reimbursement for anesthesiology is based on volume of anesthesia used - if the patient is kept under longer, more is used, and more is paid for it.

 

[Emily Lake]

Medical reimbursement is based on diagnosis and procedure, not time.

Not strictly true. Many “visiting” specialists/surgeons are contracted here, but at least some of their anesthesiologists’ time and pay are only figured after the fact. What bugs me is that they don’t disclose costs upfront, at least the costs for the theater, surgeon etc. that are known. It’s pretty obscene.

Anesthesiology is the reason we had the No Surprises Act. Sure, there were other things that got swept up with it... but far and away the primary driver of the entire law was Anesthesiology. The patient would do everything they were supposed to - pick a surgeon and a hospital in their plan, get all the prior auth and make sure everything was in order. But the patient has zero control over who the anesthesiologist is... and those kept being non-contracted and charging totally crazy amounts for both their time and the drug administered. And then if the insurer didn't pay the $500,000 for three hours of surgery, they'd balance bill the patient whatever the insurance company didn't cover.

NSA really could stand for "No Shitty Anesthesiologists" and it would do pretty much the same thing it does now.

 

[Jarhyn]

My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

Fantastic way for hospitals to pad their bill while not actually providing more benefit or treatment to the patient. Never mind that it increases risk to the patient... it's more cash for the hospital's bottom line.

Why do you think they would charge more?

Medical reimbursement is based on diagnosis and procedure, not time.

Yeah, like, the support calls were one of the things that the business was most serious about reducing or avoiding because of the overhead and impact to our business.... And to the business of the guy that does reconstructions, I'm sure, since any failed use of our product meant possible needs for reconstruction.

 

[Jarhyn]

People scrub out of surgery all the goddamn time for all sorts of reasons.

I mean, my last job was at a company that made a surgical tool.

I imagine most idiots would be suitably shocked, though, at the kind of shit that happens with surgeons, doctors, and bureaucracy.

At any rate, I will attribute this all to someone failing to actually read the text in front of them: nothing about what the surgeon said said anything about having opened the patient. The patient was "asleep and on the table".

Note that it's still mid-surgery once the patient is asleep, even before they are cut upon, because that is part of the whole event of the surgery. The doctor is "in" the surgery as soon as they are scrubbed, and in theater.

Time under anesthesia is important. It potentially has major repercussions for the patient. Time booked into an OR is expensive.

All true. It still happens though, and I'm not going to doubt that it happened, especially since it was a post-cancer reconstruction.

It's still bad but definitely not unheard of. My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

In a small private practice doing breast reconstruction, I can imagine a lot more doctor involvement, too, in the financial process.

I'm sure this has happened. I've just never had a circumstance where non-emergency surgeries were NOT pre-authorized before the patient even arrived for surgery.

I would expect that plastic surgeons who do reconstruction are a lot more pressed like this for time, since a breast reconstruction can be something desired before any number of events, and promptness could be pressured from a practice.

The thing is, the surgery in the story WAS pre-authorized, and someone from UHC didn't get the memo.

 

[Jarhyn]

My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

Fantastic way for hospitals to pad their bill while not actually providing more benefit or treatment to the patient. Never mind that it increases risk to the patient... it's more cash for the hospital's bottom line.

Why do you think they would charge more?

Medical reimbursement is based on diagnosis and procedure, not time.

Like Elixir says, some expenses are billed by time, though for most routine surgeries there's a lot of time slop on the theater scheduling. I think for the breast surgeries I'm aware of, they were often done in 20, but some would just go way longer because of a complication or other, and I didn't hear of any missed surgeries? Doesn't mean they didn't happen but it wasn't a major communicated business concern.

Mostly it was the threat to corporate image that mattered more in tech support calls.

 

[ZiprHead]

My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

Fantastic way for hospitals to pad their bill while not actually providing more benefit or treatment to the patient. Never mind that it increases risk to the patient... it's more cash for the hospital's bottom line.

Why do you think they would charge more?

Medical reimbursement is based on diagnosis and procedure, not time.

Reimbursement for anesthesiology is based on volume of anesthesia used - if the patient is kept under longer, more is used, and more is paid for it.

I did not know that. So I did a little looking. Actually we are both kinda wrong and kinda right, you right more so. But thank you for getting me looking and being a little better informed.

The formula for calculating anesthesia reimbursement is
(Base Units+Time Units)×Conversion Factor×Modifier Adjustment=Anesthesia Fee Amount

Explanation

• Base units
  The number of units assigned to an anesthesia CPT code by the Centers for Medicare & Medicaid Services (CMS)
  
  
• Time units
  The number of 15-minute increments the patient was under anesthesia
  
  
• Conversion factor (CF)
  A factor specific to the locality where the anesthesia service was performed, released annually by CMS
  
  
• Modifier adjustment
  A factor that may be applied based on the type of anesthesia service and other circumstances

 

[Loren Pechtel]

My bold.

(Source)

The absence of detail in what happened makes me suspicious. It sounds like a fairly minor incident, cleared by x-ray, why would an MRI have been done?

 

[Loren Pechtel]

Cancer surgeon has to leave surgery to talk to United Healthcare about coverage for her patient.

I'm going to call bullshit and say this cosmetic surgeon is hopping on the bandwagon and making shit up. There's no fucking way that a surgeon would scrub out of a surgery in process and talk to an insurance company. Surgeons almost never actually talk to the insurer in the first place - they're administrative and billing staff do. And they would NEVER stop in the middle of a surgery for that, like it would be reckless negligence on the part of the docter.

If this happened, her patient should sue the doctor's socks off for malpractice.

Yeah, this doesn't ring true for me, either.

I also note a shift in the claim. After anesthesia but before the scalpel, or after the cutting started? But it's not that important, either situation is not in the medical interest of the patient.

 

[Loren Pechtel]

At any rate, I will attribute this all to someone failing to actually read the text in front of them: nothing about what the surgeon said said anything about having opened the patient. The patient was "asleep and on the table".

Note that it's still mid-surgery once the patient is asleep, even before they are cut upon, because that is part of the whole event of the surgery. The doctor is "in" the surgery as soon as they are scrubbed, and in theater.

Asleep on the table means anesthesia time. That should be minimized--taking time out to talk to an insurance company is not the appropriate practice of medicine.

 

[Loren Pechtel]

People scrub out of surgery all the goddamn time for all sorts of reasons.

I mean, my last job was at a company that made a surgical tool.

I imagine most idiots would be suitably shocked, though, at the kind of shit that happens with surgeons, doctors, and bureaucracy.

At any rate, I will attribute this all to someone failing to actually read the text in front of them: nothing about what the surgeon said said anything about having opened the patient. The patient was "asleep and on the table".

Note that it's still mid-surgery once the patient is asleep, even before they are cut upon, because that is part of the whole event of the surgery. The doctor is "in" the surgery as soon as they are scrubbed, and in theater.

Time under anesthesia is important. It potentially has major repercussions for the patient. Time booked into an OR is expensive.

All true. It still happens though, and I'm not going to doubt that it happened, especially since it was a post-cancer reconstruction.

It's still bad but definitely not unheard of. My last job had me at a building where doctors would actively do precisely this, after anesthesia and before opening, for technical support.

In a small private practice doing breast reconstruction, I can imagine a lot more doctor involvement, too, in the financial process.

I can understand it happening if something happens during the surgery that the surgeon needs to talk to someone. Not good but the alternatives might be worse. But not to take a call from an insurance company.

 

[bilby]

The absence of detail in what happened My desire to handwave away anything that doesn't support my beliefs makes me suspicious.

FTFY.

 

[Loren Pechtel]

The absence of detail in what happened My desire to handwave away anything that doesn't support my beliefs makes me suspicious.

FTFY.

Stories that omit important aspects are often not very accurate.

 

[bilby]

The absence of detail in what happened My desire to handwave away anything that doesn't support my beliefs makes me suspicious.

FTFY.

Stories that omit important aspects are often not very accurate.

Yes. That's why I object to your handwaving them away.