I wish 60 minutes would also look into the practice of hospitals eliminating competition within their communities by specialists by
1. Buying up family practice clinics
2. Family practice clinics not purchased, the hospital provides those clinics with "schedulers" that schedule appointments for patients. These hospital employees receive bonuses based upon the number of patients scheduled at the hospital which is more expensive for the patient and their insurance
3. Any specialists that refuse to become employed by the hospital are put out of business by the above practice
4. This more expensive monopoly of health care may be legal but how can it be ethical or moral
The hospital I work for bought an Urgent care clinic connected to the hospital and then immediately closed it. Guess where all of the patients have to go now for health care?
I immensely enjoyed the piece. There a lot of waste in healthcare that truly does not directly benefit the patient, the doctor or the nurse but rather it is solely for the benefit of the administrators(with no medical knowledge) that run these mega health care systems as a business and not as a a tue healh care facility. BRAVO 60 minutes!!!!!!
I'm an RN in a newly created hospital position called, "Prepayment Review Specialist." My background is Utilization Review (UR) Case Management. In the UR role I checked to see that the Medicare patient's stay met criteria using "Interqual," a nationwide annual publication which reflects Medicare's latest parameters for an "inpatient" stay. If we had any doubt the stay met criteria, we would send it to an outside agency, Executive Health Resources (EHR) for their doctors to review. This company would represent the hospital to Medicare if the case was denied. My new position was created to intercept surgery cases which have a high frequency of denials by Medicare. I check the "History and Physical" prior to surgery to see that all details required are discussed by the surgeon. If not I ask the surgeon to dictate an addendum with the specific answers or cover with his expert rationale. We have many denials and we seem to be jumping through hoops to make sure we satisfy Medicare's criteria. How is Health Management Associates getting away with admitting Medicare patients without a justifiable medical necessity?
ProMED **is** designed to issue automatically orders for many tests based on the age... for example. If it is a flu season, and you come to ER with fever or cough, you will be most likely admitted at least for observations... Unnecessary tests are order all the time. IT people in hospital are generating quantum of reports on physicians that are based on the admission rate... exactly as it was stated in this reporting. Physicians are being called if they do not meet admission goals... hospitals are upcoding, adding tests, double charging...it is MESS and it all could be easily fixed - if there would be a *****true*** competition in health care (based on value). Consumers are so uneducated in this area _ they are afraid to question billing charges, question physicians, shop for providers (because of insurance limitations) and et cetera. It all can be fixed - but greed needs to be moved aside... ;-)
Not everyone is disgruntled that worked for an HMA. The Justice Department shouldn't look at the medical part of the billing. The labor Department should look into things too. A staff get over charge on their medical insurance too. Your third paycheck the health insurance is taken out. You are not allowed to use your sick time. If you accumulate it and quit. You can't have it. As employee, it's just there. You only allow to use five sick days a year. I know. I got a written up for my child being in the hospital. There is a quota!
You are so right. 18 months ago I had knee resurfacing surgery. Two days later, a tiny bubble appeared at the site, went to ER; the doc said I had an infection (wrong), ran a series of unnecessary tests including a sonogram; admitted me (shouldn't have). I spent nearly 24 hours with an IV in my right arm in excruciating pain from the constant change of antibiotic IV bottles. They billed the insurance company for over $7200. They paid about $4,000, tho I told them they should not pay any at all. I was billed the remainder. Fortunately, before they could "edit" the medical report, I got a copy of it. I had serious words with HMC, who eventually wrote off the amount. Classic example of an ER doc seeing a 74 yr old woman, making assumptions (all wrong), and admitting me, just as you reported on your program.
I currently have an Advantage plan with United Healthcare, who are in serious dispute with the Baycare hospitals here. The issue is unnecessary testing. Before tests can be run, the doctors have to jump thru some hoops. I applaud United Healthcare for "sticking" it to them.
I also got a $39.00 bill for tests, but nobody will tell me what doctor ordered them, what they were all about, and when they were conducted. I'm not paying.
I stopped going to my doctor because she had me come back every three months to tell me I was fine. She made sure I came back because she only prescribed my blood pressure meds for 90 days. I also had to go to the lab, I guess this was her way to justify my visits. I believe she was taking advantage of the insurance company because I should have been able to see her once a year unless I experienced a change. Even twice a year would ave been reasonable. I never go a bill so the insurance company was covering her bills. More people should be aware of this.
Thanks for investigating and informing the general public about the specific kind of abuses that health care reform MUST address - profiteers, not the high cost of services. Wish those wanting to cut entitlements were as interested in limiting profits and regulating service providers. GO Justice Department!
The very similar business approaches are used by other health care networks and hospitals... Many health care workers and those present during management meetings are much aware of it.
You are absolutely right. This is not an isolated incident, and it has been happening for a number of years. We can only hope that this spurs a complete investigation of all hospitals and their practices.
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I wish 60 minutes would also look into the practice of hospitals eliminating competition within their communities by specialists by
1. Buying up family practice clinics
2. Family practice clinics not purchased, the hospital provides those clinics with "schedulers" that schedule appointments for patients. These hospital employees receive bonuses based upon the number of patients scheduled at the hospital which is more expensive for the patient and their insurance
3. Any specialists that refuse to become employed by the hospital are put out of business by the above practice
4. This more expensive monopoly of health care may be legal but how can it be ethical or moral
BRAVO 60 minutes!!!!!!
I currently have an Advantage plan with United Healthcare, who are in serious dispute with the Baycare hospitals here. The issue is unnecessary testing. Before tests can be run, the doctors have to jump thru some hoops. I applaud United Healthcare for "sticking" it to them.
I also got a $39.00 bill for tests, but nobody will tell me what doctor ordered them, what they were all about, and when they were conducted. I'm not paying.