A little while back, I answered Cedric’s question regarding why all physicians do not go to “Cash Only” and avoid all insurance. I replied that physicians that went “Cash Only” in my liberal “Left Coast” community were usually the most liberal and the most “organic” ones. They “Cherry-Picked” their patients to avoid potentially sicker patients. You can’t really demand “Cash Only” when your patient has an ET tube down his throat and the other end of the ET tube is attached to a respirator. In our community, it was the “conservative” (and majority foreign-born) hospital-based specialists and Hospitalists that took on every medical “train-wreck” that rolled through the ER doors. Of course, we made far more money.

What happens when you have the guts to take the toughest cases? You do not end up with a 1.000 batting average. An 8th Grader hitting off of a T-Ball stand in an empty baseball field will have a 1.000 batting average. The best slugger in Major League Baseball will fail at least 60% of the time when facing the toughest pitchers and the toughest infielders and outfielders in international baseball.

What have liberal thinkers come up with?

“Outcomes-based payments”: The higher your medical batting average, the higher you get paid. The lower your batting average, the lower you get paid.

So, who will have the higher mortality rate? The combat surgeon taking on every mangled body that is flown in or the Dermatologist that is treating the acne of teenagers righ before the High School Prom?

With “outcomes-based payments”, who will get paid more? The best slugger in Major League Baseball or the 8th Grader hitting off a T-Ball stand in an empty baseball field?

Who are rewarded? The brave or the cowards?

This e-mail article just came into my Medscape account:

Zitat

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Physicians See Pressures to Cherry-Pick Patients

Lower reimbursements, busier practices, and the rise of outcomes-based payments are inciting more physicians to think about cherry-picking -- that is, selecting patients with better payments or fewer health problems. Many physicians admit they do it, although they may feel guilty about it, or they worry that being too aggressive in this realm could harm their practices and standing

Another form of cherry-picking, avoiding sicker patients, is more controversial. .... Physicians may also steer clear of sicker patients in order to get extra payments or bonus payments in return for better outcomes.

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This is what happens when liberals without Real World experience outside of politics get power.

Another take on it, note the pricing difference and type.

Another view on this subject

I dont find that to be true. I think people who pay cash, pay less. These doctors can hide a cash payment if they want.

I remember when almost everyone paid cash..but the fees were very reasonable. Of course, its true, that you didnt go to the doctor for the sniffles, but only went if you were really sick. Medicines, also were reasonable and we paid cash. The only thing most of us had insurance for, were hospital stays.

What ruined this, I believe, was when unions started to give their workers these policies that covered everything. Before you knew it..other insurance companies jumped on the band wagon. I didnt have this kind of coverage until the early 80s. We paid for visits and meds, ourselves. I think once these policies were out there, people abused them..running up bills that they wouldnt have, if they had to pay themselves. This is why the co-pays kept rising. I guess they figured if money had to come out of pocket, people wouldnt be so abusive.

Then..you have the drug companies, charging outrageous prices for drugs. This could have never happened if people had to buy them, themselves. Nobody could afford them..nobody would take them..so these companies wouldnt have been able to charge this prices for them. I worked for Riteaid in the early 80s as a pharmacists asst. Most people paid cash for their drugs..and those drugs didnt send anyone to the poor house.

What we had back then..was better for everyone. Even people who bordered on poor could afford a doctor visit. I switched from my pediatrician, to a family doctor in the early 80s. The fee was only 12 dollars a visit. This guy even made house calls for those too old or too ill to visit him.

I wouldnt mind if it went back to that..if these doctors could charge reasonable fees and the drug companies would price their drugs reasonably.

Quote: Justme wrote in post #2

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I don't know how I feel about this actually. In business profit is the bottom line and I am in the camp that believes we are not entitled to a professionals service

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Quote: Justme wrote in post #2

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Polybius, can you explain why cash or self insured patients are generally charged more than insured ones? I have never understood this. We are not insured but also don't go to doctors unless necessary. In most cases we have been very fortunate with honest doctors, but it is hospital policy to overcharge the uninsured.

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Quote: Mechanicos wrote in post #3

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Another take on it, note the pricing difference and type.

Another view on this subject

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Quote: Polybius wrote in post #1

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“Outcomes-based payments”: The higher your medical batting average, the higher you get paid. The lower your batting average, the lower you get paid.

So, who will have the higher mortality rate? The combat surgeon taking on every mangled body that is flown in or the Dermatologist that is treating the acne of teenagers righ before the High School Prom?

With “outcomes-based payments”, who will get paid more? The best slugger in Major League Baseball or the 8th Grader hitting off a T-Ball stand in an empty baseball field?

Who are rewarded? The brave or the cowards?

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