One Website on the Internet evaluates Medical Centers and lists them in the following order:
Johns Hopkins, Baltimore
Mayo Clinic, Rochester, Minnesota
Ronald Regan, UCLA, Los Angeles
Cleveland Clinic
Massachusetts General Hospital, Boston
New York Presbyterian University Hospital of Columbia and Cornell
University of California, San Francisco Medical Center
Hospital of the University of Pennsylvania, Philadelphia
Barnes-Jewish Hospital/Washington University, St. Louis
Brigham and Women's Hospital, Boston
Duke University Medical Center, Durham, N.C.
University of Washington Medical Center, Seattle
UP MC-University of Pittsburgh Medical Center
University of Michigan Hospitals and Health Centers, Ann Arbor
Stanford Hospital and Clinics, Stanford, CA
Vanderbilt University Medical Center, Nashville
NYU Medical Center, New York
Yale-New Haven Hospital, New Haven, Connecticut
Mount Sinai Medical Center, New York, NY
Methodist Hospital, Houston
Ohio State University Hospital, Columbus, OH
If you are able, use one of these medical centers for your medical care. Call on the telephone and ask for outpatient appointments to the Specialty Clinic if you know which one you need; or to a general medical clinic if you don't know. Not only will they accept your call and questions, they will help you with your request. Don't be intimidated because they are large clinics. Treating people is what they do.
Saturday, August 29, 2009
Friday, August 28, 2009
All Doctors should be on a Salary !
Physicians can be paid a straight fixed salary by a clinic or hospital (not the doctor's P.C.) or they can collect a fee per case. The salary (plus bonuses for exceptional services) has always provided the best level of medical care. The doctor doesn't have to hurry or constantly scrounge for more cases, and he is not rewarded for unnecessary treatment. He can do what is best for the patient and not what is best for his bank account. Seek your treatment at a large medical clinic where the doctors are salaried.
What about the patient who lives in a small town? Most large well run medical centers have satellite clinics in small towns; seek them out. If there is nothing in your town travel to the nearest large medical center and have them work with a cooperative General Practitioner or Nurse Practitioner in your town who will help with day-to-day care under the direction of the clinic physicians. Do not submit yourself or your patient to a fee-for-service scheme of $75 per office visit for allergy shots or some such.
The solution for the country is to have large well run medical clinics in the large cities in each state with satellite clinics in the small towns; and with ALL repeat ALL doctors on a fixed salary. Many large clinics are doing this; seek them out. Be sure the doctors are salaried. Ask the question. If you don't get an answer, go elsewhere.
Be particularly careful to avoid the fast moving hard to understand doctor who has a jammed wating room and who does 10 tonsillectomies or 10 arthroscopies on his operating days. You don't want to be tenth in line for anything. If he is doing 10 precedures three days or more days a week you can bet half of them are unnecessary. This physician may have a good reputation; he created it and paid for it himself. Pay no attention when the front desk clerk tells you how good he is, she works for him . Further, he probably rewards his referring doctors with a generous Christmas gift to their wives and children. This is FEE SPLITTING and is strictly against the ethical codes of all professional associations (AMA, etc.). Beware !
Physicians can be paid a straight fixed salary by a clinic or hospital (not the doctor's P.C.) or they can collect a fee per case. The salary (plus bonuses for exceptional services) has always provided the best level of medical care. The doctor doesn't have to hurry or constantly scrounge for more cases, and he is not rewarded for unnecessary treatment. He can do what is best for the patient and not what is best for his bank account. Seek your treatment at a large medical clinic where the doctors are salaried.
What about the patient who lives in a small town? Most large well run medical centers have satellite clinics in small towns; seek them out. If there is nothing in your town travel to the nearest large medical center and have them work with a cooperative General Practitioner or Nurse Practitioner in your town who will help with day-to-day care under the direction of the clinic physicians. Do not submit yourself or your patient to a fee-for-service scheme of $75 per office visit for allergy shots or some such.
The solution for the country is to have large well run medical clinics in the large cities in each state with satellite clinics in the small towns; and with ALL repeat ALL doctors on a fixed salary. Many large clinics are doing this; seek them out. Be sure the doctors are salaried. Ask the question. If you don't get an answer, go elsewhere.
Be particularly careful to avoid the fast moving hard to understand doctor who has a jammed wating room and who does 10 tonsillectomies or 10 arthroscopies on his operating days. You don't want to be tenth in line for anything. If he is doing 10 precedures three days or more days a week you can bet half of them are unnecessary. This physician may have a good reputation; he created it and paid for it himself. Pay no attention when the front desk clerk tells you how good he is, she works for him . Further, he probably rewards his referring doctors with a generous Christmas gift to their wives and children. This is FEE SPLITTING and is strictly against the ethical codes of all professional associations (AMA, etc.). Beware !
Why Costs are kept Secret !
For the Hospital:
For-Profit Hospitals will almost never attempt to quote you a cost for a given procedure -- for instance gallbladder removal. The reason is that most for-profit hospitals work on a Cost-Plus billing scheme that allows them to apply a usually marked up fee for every item allotted to the patient and then add a margin for profit and to help cover other unpaid bills. In addition, the hospital doesn't know ahead what your treatment will require. They may be willing to quote you an average cost for uncomplicated gallbladder removal but many hospitals will simply say they don't know what you will require. The really good well run hospitals will quote you a fixed price and stick to it. A few years ago a large airline negotiated the cost for heart by-pass operations with several large medical centers. These hospitals set fixed prices for heart by-pass operations and stuck to them. Most for-profit hospitals will not even consider this. The hospital medical staff really has to know what they are doing to be confident that they can carry out treatment without a mishap. For-profit hospital administrators like to see well insured patients have a complication or become seriously ill; the hospital makes more money that way.
For the Doctor:
The doctor knows full well what his charges are but he is reluctant to tell you. If you ask the cost he may say he doesn't know right off the top of his head and that his accountant or billing clerk set the prices; but don't be deceived, the doctor has full control over charges. In addition, the doctor may simply not want to explain why he is charging $10,000 for a 15 minute arthroscopy or a 1 hour gallbladder removal. When you get the bill and call to ask about it you are directed to a billing clerk who has had a lot of practice explaining charges and can give you a thousand reasons for the charge -- or she may be gone for two weeks and you will have to call back.
The simple answer is that this doctor is greedy and in the business to get rich, not to provide the best possible care in the interest of the patient. The two objectives are incompatible and mutually exclusive.
The bottom line is that it is best to ask the cost ahead of time. If you don't get an answer or the price is too high, go somewhere else. Try to find a large well-run non-profit clinic where the doctors are salaried and not paid a fee per case.
For-Profit Hospitals will almost never attempt to quote you a cost for a given procedure -- for instance gallbladder removal. The reason is that most for-profit hospitals work on a Cost-Plus billing scheme that allows them to apply a usually marked up fee for every item allotted to the patient and then add a margin for profit and to help cover other unpaid bills. In addition, the hospital doesn't know ahead what your treatment will require. They may be willing to quote you an average cost for uncomplicated gallbladder removal but many hospitals will simply say they don't know what you will require. The really good well run hospitals will quote you a fixed price and stick to it. A few years ago a large airline negotiated the cost for heart by-pass operations with several large medical centers. These hospitals set fixed prices for heart by-pass operations and stuck to them. Most for-profit hospitals will not even consider this. The hospital medical staff really has to know what they are doing to be confident that they can carry out treatment without a mishap. For-profit hospital administrators like to see well insured patients have a complication or become seriously ill; the hospital makes more money that way.
For the Doctor:
The doctor knows full well what his charges are but he is reluctant to tell you. If you ask the cost he may say he doesn't know right off the top of his head and that his accountant or billing clerk set the prices; but don't be deceived, the doctor has full control over charges. In addition, the doctor may simply not want to explain why he is charging $10,000 for a 15 minute arthroscopy or a 1 hour gallbladder removal. When you get the bill and call to ask about it you are directed to a billing clerk who has had a lot of practice explaining charges and can give you a thousand reasons for the charge -- or she may be gone for two weeks and you will have to call back.
The simple answer is that this doctor is greedy and in the business to get rich, not to provide the best possible care in the interest of the patient. The two objectives are incompatible and mutually exclusive.
The bottom line is that it is best to ask the cost ahead of time. If you don't get an answer or the price is too high, go somewhere else. Try to find a large well-run non-profit clinic where the doctors are salaried and not paid a fee per case.
Subscribe to:
Posts (Atom)