but the landscaper has a photo of the clean yard after they finished. They send it to you but you ( as the insurance company) say they need to call a specific time and speak to your 12y/o who is the yard representative of the house.
The 12 y/o say ‘no you stink’ and hangs up. Then you send the landscaper a letter saying ‘sorry your peer to peer was denied’
( I know this is exaggerating a bit and made to sound funny but it mostly works like that in healthcare )
The pharmacies issue is a constant problem: patient lives out of town so prescription is sent to his home pharmacy at his request, on the day of discharge he realized his pharmacy is closed and wants them sent to a local pharmacy, of course this always happens at 5pm when you are driving in traffic, the patient is angry because they want to leave but there is not much you can do. This happens very frequently, doesnt matter if you ask ahead of time for the patient to confirm the pharmacy, something inevitably happens.
The other issue is peer to peers and prior authorizations, these take up a significant amount of time and are essentially ways the insurance companies put barriers to care and reduce their costs.
I think some of your ideas could work but good luck getting anything past the politicians, some of these things would be expensive and others would be unpopular to those that donate to the politicians.
For your first example, wouldn't the friction be reduced just by telling patients the business hours of the pharmacies nearby? I hate how this question is always posed, as if I'm supposed to come up with a name and address out of a hat. If it's the middle of the night or Christmas Eve and I'm trying to get medicine for the baby, the provider probably has a better intuition than myself as to which pharmacy will actually serve me. If I ask explicitly, the provider is usually happy to suggest some options. Even a simple web interface listing hours of operation would be better than the current method, where the patient is expected to pick a pharmacy from memory before they even know what medicine they need or how long it will be before they are discharged.
This setup is crazy, as someone from another country.
Why don't you have a unified system for the pharmacies and doctors to tap into?
In my country, if I get a prescription it goes into my card. Then any pharmacy can read the card, see what prescriptions are yet not used, and provide the product (which marks the prescription as covered). Recurring products, like allergy medication or chronic illnesses, become automatically available again after a certain time, like a cooldown. You only need doctor intervention during the original diagnosis and prescription, or after rare issues (like needing an extra prescription because you lost the meds).
I'd have thought this system or a very similar one is universal.
We used to! Doctor would write prescription on a pad, and you could take the script to any pharmacy.
Of course, doctor penmanship is terrible, and we're going paperless, so we've got to digitize. And every doctor's office and every pharmacy has their own system, and sometimes they can talk (but I think there's a lot of faxing behind the scenes)
Of course, you can't know what drugs will be covered, so the doctor has to guess, and if they guess wrong, the pharamacist will want to check with the doctor to see if something else is OK to save you money, but nobody can be reached, ever.
The docs dont get paid per hour, they are salaried, so 2 docs is double the cost of 1 doc.
This is why they are overworked, why pay 2 docs if 1 can do the work, the burnout of the doc is irrelevant as there are more docs to hire after they burn-out.
Perhaps if we didn't expect superhuman schedules from doctors, doctors wouldn't command as much of a cost as they do now.
From the doctors I know, it seems like most don't get into it for the money, but they put up with it long-term because of the money. If we treated them better and increased supply, they would almost certainly cost less.
sometimes, but extra hours dont get paid extra, so very little incentive to do so. there are many different models for compensation but you can think of it as a 'fixed salary with optional bonuses'.
EDIT to add:
Most places have a base + bonus structure. You get your base salary, and you see patients, for each patient seen you generate 'RVUs' which is how your group/practice generates income ( by billing insurance companies ). Once you generate enough RVUs to cover your base salary, you start accumulating 'bonus' and that gets paid out down the line using whatever formula your employer uses. There is some variation to this but for the most part groups follow a similar scheme.
EDIT #2: This is US centric, i dont know how other countries do it.
Yes I don’t get the comments about salary vs hs. You need the same amount of people. The question is if you have 3 people doing 24hs shifts or 3 people doing 3 8hs shift a day… has nothing to do with more people/salary/money is just organization of work.
Other thing I have started doing is to stop doing any upgrade for things that are already working locally. Example: no more upgrades for HP printer software.
The thing is that may not have saved them here. They did an update to make it stop working. You would need to be local only and stay there and never use the online features.
many smart home products use different protocols than wifi. This means they will not be updated without your knowledge and cannot connect online themselves.
Where I grew up the data for murders is curated in such a way that anybody that dies 24 after being attacked is not considered a ‘murder’. Tehy do this to reduce the statistical murder rate.
Slightly related, my uni id was a prefix for the campus + year
of admission + serial number
the serial number was sequential based on last name, you could essentially guess anyones student id if you had a couple of data points of last name : serial number
As far as I know no one used it for nefarious purposes, but it was a cool party trick to guess someone’s number.
What would happen if doctors simply refused to do more then 60 hours a week? -> you can get sued for patient abandonment if you refuse to followup on a patient you are responsible for
Is there really enough supply of new doctors coming in that the hospital can just fire them all and replace them with doctors willing to burn themselves out? -> in part yes there are ( in some fields) but what would happen is that patients would be shifted to other facilities that have staff to see the patients, also when you have 400-500k of school debt its hard to refuse work
Or would it mean the hospital would have no choice but to hire additional doctors so that each one would only have to work a sustainable number of hours? -> this happens as well, they hire locum tenens docs to fill in gaps ( higher short term expense in exchange for not giving staff docs what they need)
> you can get sued for patient abandonment if you refuse to followup on a patient you are responsible for
Sure, but that isn't the case in this linked article, it seems. Being on call for emergencies, doing elective surgeries, refusing to do that doesn't count as patient abandonment as i understand it. Only when you are actively taking care of someone can you not leave them.
> in part yes there are ( in some fields) but what would happen is that patients would be shifted to other facilities that have staff to see the patients, also when you have 400-500k of school debt its hard to refuse work
Ah, yeah then that's the main problem. There's such an excess of supply that hospitals can afford to treat doctors like crap. Same idea Amazon has about its workers. In that case, hopefully articles like this will make people realize becoming a doctor is a bad choice, and reduce the supply and allow stronger employee bargaining positions.
Of course stronger regulations would always be a better option for this case, but i don't see that happening.
In the end I don't know where the solution lies, sometimes I feel the best solution is to re-design everything from the ground up. Other times I feel like regulation would help, but it would have to come from someone who practices actual medicine, bureaucrat.
Is there some kind of trick to getting the CDs to load? I've tried Firefox and Chromium, nothing seems to happen on either when clicking on the CDs, no console errors.
I am just a few minutes walk from my local grocery store, so I go frequently. Rarely use a cart, just my canvas bag. Will there be portable scanners, or will I have to drag a cart around to benefit from real time scanning?
Probably a good idea, I pretty much eliminated them from the list of possibilities when shopping for a car this year because of this. I’m just one data point but I’m pretty sure im not the only lost sale.
I’m curious about GM and their decision to stop supporting CarPlay. I probably was never going to buy a GM anyway, but CarPlay support is a must-have for me.
I find the subscription model leaves a bad taste in my mouth. I’d rather pay up front or pay to add it later. I also firmly believe in voting with you wallet and it doesnt matter what their marketing says, they are backtracking because it did not generate the income they hoped.
The 12 y/o say ‘no you stink’ and hangs up. Then you send the landscaper a letter saying ‘sorry your peer to peer was denied’
( I know this is exaggerating a bit and made to sound funny but it mostly works like that in healthcare )