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originally posted by: Phoenix
a reply to: carewemust
That's valid issue,
Short term even were congress to pass anything putting system changes into practice would probably take longer than September and it hard to imagine even by January.
You're right, many will be left in a lurch.
I myself have been in lurch for sometime now.
Freeze it in position till congress acts via E.O or something similar?
I hear you loud and clear as I'm forced to wing it and hope nothing happens health wise as this mess works way slowly through spaghetti grinder that is our congress.
I gotta problem with that if I am understanding your position.
There are no standards or guidelines?
So, I need stitches.
Urgent care #1 charges $75.00
My doctor charges $50.00
My neighbor's doctor charges $35.00
Urgent care #2 charges $45.00....but if you pay at the time of service, it is $32.00
The ER charges $85.00
And on it goes.
You cannot shop around every time you want medical care.
5,000% price increase on a drug for a rare infection that made Martin Shkreli, then chief executive of Turing Pharmaceuticals, “the most hated man on the Internet.” But Shkreli’s was an incremental innovation in price gouging. Before that, we had the case of Makena, used to prevent pre-term birth. It was launched in 2011 at a price of $1,500 when a similar drug was previously available, from compounding pharmacies, for $20. The strategy basically worked: AMAG Pharmaceuticals, which now owns Makena, booked sales of $93 million in the third quarter of last year.
Why does this keep happening? Well, with the exception of Shkreli, enabled by a thicket of market inefficiencies, because it’s the law. And that’s very much the case for Marathon and Emflaza.
UPDATED 08/22/2016, including a statement from Mylan at the end] Mylan MYL +0.40% pharmaceutical company has a virtual monopoly on EpiPens after a voluntary recall felled their only competitor*, Sanofi’s Auvi-Q, over possible dosage miscalibrations. It’s not the drug being delivered that brings the bucks, though—epinephrine’s a cheap generic. The cost trickery is in the delivery system, the Mylan EpiPen.
The EpiPen’s been around since 1977, but Mylan acquired the autoinjector—which precisely calibrates the epinephrine dosage—in 2007. The patient now pays about 400% more for this advantage to receive a dollar’s worth of the lifesaving drug: EpiPens were about $57 when Mylan acquired it. Today, it can empty pockets of $500 or more in the U.S. (European nations take a different approach to these things).
American Medical Association President Robert Wah recognizes this residency bottleneck. “U.S. residency program positions have not increased at an adequate rate to accommodate the expanding number of U.S. medical graduates and the current IMG [International Medical Group] applicant pool,” he said in an email.
Even if the AMA were to magically produce a few thousand more residency slots, it would barely make a dent in 91,500 projected doctor shortage.
Whittling down the shortage will likely take a combination of measures.
A third fear is that loosening regulations would negatively affect U.S. medical schools. If coming back to the U.S. were easier, Americans might be more likely to study in places like England and Israel because becoming a doctor would be both cheaper and faster overseas.
Further, an influx of doctors could impact a more sensitive matter—with an increased doctor supply, salaries among America’s white-coats would almost certainly go down.
“Nobody wants to share their pie,” Alomran says. “This is the same everywhere and is not unique to medicine, in my opinion.”
originally posted by: carewemust
a reply to: infolurker
And these "gouge" practices are custom made for President Trump to show that he is indeed on the side of the consumer..the little guy.
I already understand why Congress turns a blind eye to sick Americans being hurt by pharmaceutical price gouging. But Donald Trump can rise above their criminality, and force the prices lower... just like he did for some airplane contract earlier in the year.
originally posted by: TheRedneck
a reply to: infolurker
That's a lot of information! Thank you!
Gonna take some time to sort through it all, but I will start today. I may or may not have enough time to address all of those problems in my plan, but it sounds like a second bill aimed primarily at pharmaceuticals, and a third aimed primarily at medical training could be useful.
Bundled payments will be the catalyst that finally motivates provider teams to work together to understand the actual costs of each step in the entire care process, learn how to do things better, and get care right the first time. By encouraging competition for the treatment of individual conditions on the basis of quality and price, bundled payments also reward providers for standardizing care pathways, eliminating services and therapies that fail to improve outcomes, better utilizing staff to the top of their skills, and providing care in the right facilities. If providers use ineffective or unnecessary therapies or services, they will bear the cost, making bundled payments a check against overtreatment.
The result will be not just a downward “bend” in the cost curve—that is, a slower increase—but actual cost reduction. Our research suggests that savings of 20% to 30% are feasible in many conditions. And, because bundled payments are contingent on good outcomes, the right kind of cost reduction will take place, not cost cutting at the expense of quality.
The bottom line is that capitation is the wrong way to pay for health care. It is a top-down approach that achieves some cost savings by targeting low-hanging fruit such as readmission rates, expensive drugs, and better management of post-acute care. But it does not really change health care delivery, nor does it hold providers accountable for efficiency and outcomes where they matter to patients—in the treatment of their particular condition. Capitation’s savings also come at the high cost of restricting patient choice and inhibiting provider competition.
Let’s consider the alternative.
Paying for Value: Bundled Payments
For virtually all types of products and services, customers pay a single price for the whole package that meets their needs. When purchasing a car, for example, consumers don’t buy the motor from one supplier, the brakes from another, and so on; they buy the complete product from a single entity. It makes just as little sense for patients to buy their diagnostic tests from one provider, surgical services from another, and post-acute care from yet another. Bundled payments may sound complicated, but in setting a single price for all the care required to treat a patient’s particular medical condition, they actually draw on the approach long used in virtually every other industry.
Bundled payments have existed in health care for some time in isolated fields such as organ transplantation. They are also common for services that patients pay for directly, such as Lasik eye surgery, plastic surgery, and in vitro fertilization.
To maximize value for the patient, a bundled payment must meet five conditions:
originally posted by: TheRedneck
a reply to: TXTriker
I actually like that idea, but I prefer to go by the rule of thumb that regulations should be as little as possible. There is nothing in my plan that would prevent such a system, so considering the level playing field for doctors to enter the marketplace, this is an idea which should take off on its own. Especially if there are examples of it working in some areas where it has been tried.
Since any prohibitions are at the local/state level, I don't particularly like the idea of bringing such power to the Federal level. It would be nice if Obamacare hadn't brought any power to the Federal level, but it is what it is.