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DIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. HOSPITAL FINANCIAL ANALYSIS MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25HOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of HEALTHCARE EXPENDITURES Introduction. According to CMS, a total of $3.492 trillion was spent on healthcare in the United States in 2017. Of that, $2.961 trillion was spent on personal healthcare (directly on patient care) and the remaining $531 billion was spent on research, administrative costs and HOSPITAL UTILIZATION The following three graphs from AHA data show this declining hospital inpatient utilization: Figure 1: Hospital censuses for all U.S. hospitals have been declining since 1981. Figure 2: The total number of admissions to U.S. hospitals dropped significantly after the implementation of Diagnostic Related Groups (DRGs) as criteria forMedicare
CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
MEDICATION TABLE
Below is an alphabetical listing for multiple doses of about 200 separate generic medications. This table also lists the average price all retail pharmacies in the U.S. paid for each of these medications as well as the price for up to a six month’s supply of the medication as listed at goodrx.com in March 2018. If you click on the listed price, it will give you the current listed price. MEDICARE PART D AND MEDICARE ADVANTAGE What very few people are told, though, is exactly how much that fine really is. That “enormous” fine is 1% of the average Part D premium price for each month you delay buying into a Part D plan. In 2020 the average Part D premium price is $32.74 per month. That means you’ll owe about $3.93 per month extra for every year you delay. COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICATIONS: THE BAD NEWS Harvoni costs $1,125 a pill. Those requiring Sovaldi or Harvoni to treat their hepatitis c will need to take one pill a day for 12 weeks or 84 pills total. That’s $84,000 for a course of Sovaldi and $94,500 for a course of Harvoni. As I said before, Sovaldi and Harvoniaren’t the
LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
BRAND NAME MEDICATION PRICES Figure 1: The annual average rate of inflation for 400 brand name prescription medication listings has ranged between 12-17% from October 2012 to October 2016. Here’s a PDF list of the medications I compared along with their prices to show how much they cost and how much their prices have risen. Surprisingly, the prices of brand name TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried HOSPITAL FINANCIAL ANALYSISHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company is MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
MEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried HOSPITAL FINANCIAL ANALYSISHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company is MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
MEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. HOSPITAL UTILIZATION The following three graphs from AHA data show this declining hospital inpatient utilization: Figure 1: Hospital censuses for all U.S. hospitals have been declining since 1981. Figure 2: The total number of admissions to U.S. hospitals dropped significantly after the implementation of Diagnostic Related Groups (DRGs) as criteria forMedicare
CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
AHA RECORDS
The following PDF documents came directly from the American Hospital Association’s website and were used, in part, for my analysis of both financial and utilization trends for all U.S. hospitals. The data I extracted from these reports is here AHA 2018 appendix AHA 2016 Full Report AHA 2015 Full Report AHA 2013 Full Report AHA 2010 FinancialAppendix AHA 2010
MEDICATION TABLE
Below is an alphabetical listing for multiple doses of about 200 separate generic medications. This table also lists the average price all retail pharmacies in the U.S. paid for each of these medications as well as the price for up to a six month’s supply of the medication as listed at goodrx.com in March 2018. If you click on the listed price, it will give you the current listed price. MEDICAL MALPRACTICE: MYTHS AND REALITIES Figure 1: My medical malpractice insurance bill for 2019. That’s right, $4,988.02 for the whole year! (It says $5,087.02 because they want a voluntary $99.00 yearly PAC contribution that they add to the the bill.) That’s not an aberration either. Since 2011, I’ve paid an average of less than $5,000 a year for my malpractice premiums and COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICARE DRUG COSTS
Medicare Part B Medication Costs. The total spent for all medications covered under Medicare Part B was $109.8 billion from 2012-2016. Although an average of about 450 separate medications were covered by Part B benefits each of those years, $64.5 billion, or about 59% of that total spending went toward the administration of just 20different
BRAND NAME MEDICATION PRICES Figure 1: The annual average rate of inflation for 400 brand name prescription medication listings has ranged between 12-17% from October 2012 to October 2016. Here’s a PDF list of the medications I compared along with their prices to show how much they cost and how much their prices have risen. Surprisingly, the prices of brand name LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
LIVER TRANSPLANT BILLING The following is an itemized list of all paid billing charges for a patient who received chemotherapy in 2016 then radio frequency ablation therapy and a liver transplant in 2017 for a diagnosis of liver cancer. For each year from 2016-2018, all paid medical services the patient received for any reason are listed as well as the billingcodes that
TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried HOSPITAL FINANCIAL ANALYSISHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worriedHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of HOSPITAL FINANCIAL ANALYSIS PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company is MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
MEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. HOSPITAL UTILIZATION The following three graphs from AHA data show this declining hospital inpatient utilization: Figure 1: Hospital censuses for all U.S. hospitals have been declining since 1981. Figure 2: The total number of admissions to U.S. hospitals dropped significantly after the implementation of Diagnostic Related Groups (DRGs) as criteria forMedicare
AHA RECORDS
The following PDF documents came directly from the American Hospital Association’s website and were used, in part, for my analysis of both financial and utilization trends for all U.S. hospitals. The data I extracted from these reports is here AHA 2018 appendix AHA 2016 Full Report AHA 2015 Full Report AHA 2013 Full Report AHA 2010 FinancialAppendix AHA 2010
CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
MEDICATION TABLE
Below is an alphabetical listing for multiple doses of about 200 separate generic medications. This table also lists the average price all retail pharmacies in the U.S. paid for each of these medications as well as the price for up to a six month’s supply of the medication as listed at goodrx.com in March 2018. If you click on the listed price, it will give you the current listed price. MEDICAL MALPRACTICE: MYTHS AND REALITIES Figure 1: My medical malpractice insurance bill for 2019. That’s right, $4,988.02 for the whole year! (It says $5,087.02 because they want a voluntary $99.00 yearly PAC contribution that they add to the the bill.) That’s not an aberration either. Since 2011, I’ve paid an average of less than $5,000 a year for my malpractice premiums and COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICARE DRUG COSTS
Medicare Part B Medication Costs. The total spent for all medications covered under Medicare Part B was $109.8 billion from 2012-2016. Although an average of about 450 separate medications were covered by Part B benefits each of those years, $64.5 billion, or about 59% of that total spending went toward the administration of just 20different
BRAND NAME MEDICATION PRICES Figure 1: The annual average rate of inflation for 400 brand name prescription medication listings has ranged between 12-17% from October 2012 to October 2016. Here’s a PDF list of the medications I compared along with their prices to show how much they cost and how much their prices have risen. Surprisingly, the prices of brand name LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
LIVER TRANSPLANT BILLING The following is an itemized list of all paid billing charges for a patient who received chemotherapy in 2016 then radio frequency ablation therapy and a liver transplant in 2017 for a diagnosis of liver cancer. For each year from 2016-2018, all paid medical services the patient received for any reason are listed as well as the billingcodes that
TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried HOSPITAL FINANCIAL ANALYSISHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried HOSPITAL FINANCIAL ANALYSISHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. HOSPITAL UTILIZATION The following three graphs from AHA data show this declining hospital inpatient utilization: Figure 1: Hospital censuses for all U.S. hospitals have been declining since 1981. Figure 2: The total number of admissions to U.S. hospitals dropped significantly after the implementation of Diagnostic Related Groups (DRGs) as criteria forMedicare
AHA RECORDS
The following PDF documents came directly from the American Hospital Association’s website and were used, in part, for my analysis of both financial and utilization trends for all U.S. hospitals. The data I extracted from these reports is here AHA 2018 appendix AHA 2016 Full Report AHA 2015 Full Report AHA 2013 Full Report AHA 2010 FinancialAppendix AHA 2010
CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
MEDICATION TABLE
Below is an alphabetical listing for multiple doses of about 200 separate generic medications. This table also lists the average price all retail pharmacies in the U.S. paid for each of these medications as well as the price for up to a six month’s supply of the medication as listed at goodrx.com in March 2018. If you click on the listed price, it will give you the current listed price. MEDICAL MALPRACTICE: MYTHS AND REALITIES Figure 1: My medical malpractice insurance bill for 2019. That’s right, $4,988.02 for the whole year! (It says $5,087.02 because they want a voluntary $99.00 yearly PAC contribution that they add to the the bill.) That’s not an aberration either. Since 2011, I’ve paid an average of less than $5,000 a year for my malpractice premiums and COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICARE DRUG COSTS
Medicare Part B Medication Costs. The total spent for all medications covered under Medicare Part B was $109.8 billion from 2012-2016. Although an average of about 450 separate medications were covered by Part B benefits each of those years, $64.5 billion, or about 59% of that total spending went toward the administration of just 20different
BRAND NAME MEDICATION PRICES Figure 1: The annual average rate of inflation for 400 brand name prescription medication listings has ranged between 12-17% from October 2012 to October 2016. Here’s a PDF list of the medications I compared along with their prices to show how much they cost and how much their prices have risen. Surprisingly, the prices of brand name LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
LIVER TRANSPLANT BILLING The following is an itemized list of all paid billing charges for a patient who received chemotherapy in 2016 then radio frequency ablation therapy and a liver transplant in 2017 for a diagnosis of liver cancer. For each year from 2016-2018, all paid medical services the patient received for any reason are listed as well as the billingcodes that
TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost.DIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOU HOSPITAL FINANCIAL ANALYSIS PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost.DIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOU HOSPITAL FINANCIAL ANALYSIS PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 INTRODUCTION: HIDDEN COST A View of Healthcare Costs from the Inside Notice If you are interested in attending one of my Medicare seminars, contact me here for more information. My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook MostHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
MEDICATION TABLE
Below is an alphabetical listing for multiple doses of about 200 separate generic medications. This table also lists the average price all retail pharmacies in the U.S. paid for each of these medications as well as the price for up to a six month’s supply of the medication as listed at goodrx.com in March 2018. If you click on the listed price, it will give you the current listed price. MEDICATIONS: THE BAD NEWS Harvoni costs $1,125 a pill. Those requiring Sovaldi or Harvoni to treat their hepatitis c will need to take one pill a day for 12 weeks or 84 pills total. That’s $84,000 for a course of Sovaldi and $94,500 for a course of Harvoni. As I said before, Sovaldi and Harvoniaren’t the
COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICARE SUPPLEMENTAL INSURANCE Figure 6: 2012 premiums for Medicare Supplemental coverage. For Plan F full coverage, Medicare recipients paid $133 a month if they were 65. But you’ll notice that 71 year olds were paying $212 a month. That’s about a 60% increase in premium cost in just MEDICARE PART D AND MEDICARE ADVANTAGE What very few people are told, though, is exactly how much that fine really is. That “enormous” fine is 1% of the average Part D premium price for each month you delay buying into a Part D plan. In 2020 the average Part D premium price is $32.74 per month. That means you’ll owe about $3.93 per month extra for every year you delay. LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
BRAND NAME MEDICATION PRICES Figure 1: The annual average rate of inflation for 400 brand name prescription medication listings has ranged between 12-17% from October 2012 to October 2016. Here’s a PDF list of the medications I compared along with their prices to show how much they cost and how much their prices have risen. Surprisingly, the prices of brand name TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost.DIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOU HOSPITAL FINANCIAL ANALYSIS PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost.DIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worried MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOU HOSPITAL FINANCIAL ANALYSIS PHARMA'S 50 BEST SELLERSOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company isMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MALPRACTICE STATISTICS The number of large claims ($500,000 or more) against health care providers has been far more constant over that same period of time. Figure 5: Number of paid medical malpractice claims in the U.S. each year that were settled for $500,000 or more. The average amount paidon
THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research. ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 INTRODUCTION: HIDDEN COST A View of Healthcare Costs from the Inside Notice If you are interested in attending one of my Medicare seminars, contact me here for more information. My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook MostHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
MEDICATION TABLE
Below is an alphabetical listing for multiple doses of about 200 separate generic medications. This table also lists the average price all retail pharmacies in the U.S. paid for each of these medications as well as the price for up to a six month’s supply of the medication as listed at goodrx.com in March 2018. If you click on the listed price, it will give you the current listed price. MEDICATIONS: THE BAD NEWS Harvoni costs $1,125 a pill. Those requiring Sovaldi or Harvoni to treat their hepatitis c will need to take one pill a day for 12 weeks or 84 pills total. That’s $84,000 for a course of Sovaldi and $94,500 for a course of Harvoni. As I said before, Sovaldi and Harvoniaren’t the
COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICARE SUPPLEMENTAL INSURANCE Figure 6: 2012 premiums for Medicare Supplemental coverage. For Plan F full coverage, Medicare recipients paid $133 a month if they were 65. But you’ll notice that 71 year olds were paying $212 a month. That’s about a 60% increase in premium cost in just MEDICARE PART D AND MEDICARE ADVANTAGE What very few people are told, though, is exactly how much that fine really is. That “enormous” fine is 1% of the average Part D premium price for each month you delay buying into a Part D plan. In 2020 the average Part D premium price is $32.74 per month. That means you’ll owe about $3.93 per month extra for every year you delay. LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
BRAND NAME MEDICATION PRICES Figure 1: The annual average rate of inflation for 400 brand name prescription medication listings has ranged between 12-17% from October 2012 to October 2016. Here’s a PDF list of the medications I compared along with their prices to show how much they cost and how much their prices have risen. Surprisingly, the prices of brand name TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worriedHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of HOSPITAL FINANCIAL ANALYSISOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company is PHARMA'S 50 BEST SELLERSMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MEDICARE SUPPLEMENTAL INSURANCE Figure 6: 2012 premiums for Medicare Supplemental coverage. For Plan F full coverage, Medicare recipients paid $133 a month if they were 65. But you’ll notice that 71 year olds were paying $212 a month. That’s about a 60% increase in premium cost in just ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost.DIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worriedHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOU HOSPITAL FINANCIAL ANALYSISOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company is PHARMA'S 50 BEST SELLERSMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MEDICARE SUPPLEMENTAL INSURANCE Figure 6: 2012 premiums for Medicare Supplemental coverage. For Plan F full coverage, Medicare recipients paid $133 a month if they were 65. But you’ll notice that 71 year olds were paying $212 a month. That’s about a 60% increase in premium cost in just ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 INTRODUCTION: HIDDEN COST A View of Healthcare Costs from the Inside Notice If you are interested in attending one of my Medicare seminars, contact me here for more information. My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook Most HOSPITAL UTILIZATION The following three graphs from AHA data show this declining hospital inpatient utilization: Figure 1: Hospital censuses for all U.S. hospitals have been declining since 1981. Figure 2: The total number of admissions to U.S. hospitals dropped significantly after the implementation of Diagnostic Related Groups (DRGs) as criteria forMedicare
CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
MEDICARE PART D AND MEDICARE ADVANTAGE What very few people are told, though, is exactly how much that fine really is. That “enormous” fine is 1% of the average Part D premium price for each month you delay buying into a Part D plan. In 2020 the average Part D premium price is $32.74 per month. That means you’ll owe about $3.93 per month extra for every year you delay. THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research.MEDICARE DRUG COSTS
Medicare Part B Medication Costs. The total spent for all medications covered under Medicare Part B was $109.8 billion from 2012-2016. Although an average of about 450 separate medications were covered by Part B benefits each of those years, $64.5 billion, or about 59% of that total spending went toward the administration of just 20different
GENERIC MEDICATION PRICES My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook Summary 1. The average price of generic medications in the U.S. fell by about 12% in 2017. 2. This decline in generic medicationprices is a welcome
COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICAL MALPRACTICE: MYTHS AND REALITIES Figure 1: My medical malpractice insurance bill for 2019. That’s right, $4,988.02 for the whole year! (It says $5,087.02 because they want a voluntary $99.00 yearly PAC contribution that they add to the the bill.) That’s not an aberration either. Since 2011, I’ve paid an average of less than $5,000 a year for my malpractice premiums and LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worriedHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of HOSPITAL FINANCIAL ANALYSISOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company is PHARMA'S 50 BEST SELLERSMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MEDICARE SUPPLEMENTAL INSURANCE Figure 6: 2012 premiums for Medicare Supplemental coverage. For Plan F full coverage, Medicare recipients paid $133 a month if they were 65. But you’ll notice that 71 year olds were paying $212 a month. That’s about a 60% increase in premium cost in just ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 TRUE COST OF HEALTH CARE To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. MEDICATIONS: WHAT YOUR PHARMACIST WON'T TELL YOUDIAGNOSTIC TESTS
My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook For low cost diagnostic tests without insurance visit: Afordablescan.com Clear Health Costs A few years ago, a patient of mine called my office because she was worriedHOSPITAL BILLING
From the first line, you can see that the total bill came to $21,274.49, or about $10,000/day for two days. (The services leading to that cost are on the left: a couple of $2,500 CAT scans, a $4,400 ER charge, etc.) On the next line is the amount the insurance company paid: $2,052.95—just less than 10% of HOSPITAL FINANCIAL ANALYSISOFFICE BILLING
Figure 2: EOB from Aetna. United Health let me have $68.74 for a 99213 in July 2015 ($25 from the patient and $41.26 from United Health) and Blue Cross allowed $74.79 for a 99213 also in July 2015. So you can already see that each different insurance company is PHARMA'S 50 BEST SELLERSMEDICARE PART B
MRIs might cost as little as $342 for a simple MRI of the elbow without using any contrast dye (73221) to as much as nearly $900 for complex diagnostic MRIs used in the workup of some cancers. Most MRIs cost less than $600, though, so the co-insurance is normally less than $120. Medicare Part B now covers most routine blood tests at 100% but MEDICARE SUPPLEMENTAL INSURANCE Figure 6: 2012 premiums for Medicare Supplemental coverage. For Plan F full coverage, Medicare recipients paid $133 a month if they were 65. But you’ll notice that 71 year olds were paying $212 a month. That’s about a 60% increase in premium cost in just ALABAMA MEDICAL MALPRACTICE SUMMARY AND STATISTICS TORT Alabama Medical Malpractice Summary and Statistics Tort Reform Law: None Population in 2014: 4,849,377 Number of Licensed Physicians1 in 2014: 16,064 Number of Paid Medical Malpractice claims per 100 physicians in 2014: 0.25 INTRODUCTION: HIDDEN COST A View of Healthcare Costs from the Inside Notice If you are interested in attending one of my Medicare seminars, contact me here for more information. My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook Most HOSPITAL UTILIZATION The following three graphs from AHA data show this declining hospital inpatient utilization: Figure 1: Hospital censuses for all U.S. hospitals have been declining since 1981. Figure 2: The total number of admissions to U.S. hospitals dropped significantly after the implementation of Diagnostic Related Groups (DRGs) as criteria forMedicare
CONCLUSION: HOW DID WE GET HERE AND WHY IS THIS SO HARD TO 6) Health Insurance Companies: There is no single “bad guy” responsible for pocketing all of the money in our health care system. The money in health care is spread around rather evenly throughout the industry. But the health insurance companies bear most of the blamefor
MEDICARE PART D AND MEDICARE ADVANTAGE What very few people are told, though, is exactly how much that fine really is. That “enormous” fine is 1% of the average Part D premium price for each month you delay buying into a Part D plan. In 2020 the average Part D premium price is $32.74 per month. That means you’ll owe about $3.93 per month extra for every year you delay. THE PHARMACEUTICAL INDUSTRY The pill most likely costs just a few cents to manufacture (we know that from the cost of the generics), so the $14.37 is mostly profit. But they charge (us in the U.S.) $14.37, they say, to cover the cost of discovering it. Yet from their own statements, only about $2.44 of the $14.37 (17%) goes into research.MEDICARE DRUG COSTS
Medicare Part B Medication Costs. The total spent for all medications covered under Medicare Part B was $109.8 billion from 2012-2016. Although an average of about 450 separate medications were covered by Part B benefits each of those years, $64.5 billion, or about 59% of that total spending went toward the administration of just 20different
GENERIC MEDICATION PRICES My new book The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States Can now be purchased on Amazon. Here are the links: Paperback eBook Summary 1. The average price of generic medications in the U.S. fell by about 12% in 2017. 2. This decline in generic medicationprices is a welcome
COST REPORT ANALYSIS METHOD Cost Report Analysis Method. Every hospital in the US that accepts Medicare (which includes nearly every hospital in the US) is required to give a detailed financial report to the Centers for Medicare and Medicaid Service (CMS) each year. These financial reports are called Medicare Cost Reports and all of the data from these reports goingback
MEDICAL MALPRACTICE: MYTHS AND REALITIES Figure 1: My medical malpractice insurance bill for 2019. That’s right, $4,988.02 for the whole year! (It says $5,087.02 because they want a voluntary $99.00 yearly PAC contribution that they add to the the bill.) That’s not an aberration either. Since 2011, I’ve paid an average of less than $5,000 a year for my malpractice premiums and LIVER TRANSPLANT CASE STUDY 2017. In 2017, she got her liver transplant so her medical care got even more expensive. The total amount billed for all 216 medical services she received in 2017 (including her three hospitalizations) was $900,744. Again, that certainly sounds like a lot of money but, once again, Medicare only approved of about 17 percent of thesecharges, or
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* Introduction
* Healthcare
* Medications
* Introduction
* The Bad News
* Medication Table
* Generic Medication Prices * Brand Name Medication Prices * Pharmacy Price Index * Pharmaceutical Industry* Industry Analysis
* Pharma’s 50 Best Sellers* Financial Index
* Billing
* Hospital Billing
* Office Billing
* Diagnostic Tests
* High Deductibles
* Medicare
* Medicare Supplemental Insurance * Liver Transplant Case Study * Medicare Part D and Medicare Advantage * Medicare Part D Case Study * Medicare Drug Costs* Medicare Part B
* Medical Malpractice * Myths and Realities * Malpractice Statistics* Hospitals
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* Pharmacy Financial Index * Pharmaceutical Financial Index * Health Insurance Financial Index * Cost Report Analysis Method* Conclusion
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* Introduction
* Healthcare
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* Medications
__
* Introduction
* The Bad News
* Medication Table
* Generic Medication Prices * Brand Name Medication Prices * Pharmacy Price Index * Pharmaceutical Industry__
* Industry Analysis
* Pharma’s 50 Best Sellers* Financial Index
* Billing
__
* Hospital Billing
* Office Billing
* Diagnostic Tests
* High Deductibles
* Medicare
__
* Medicare Supplemental Insurance * Liver Transplant Case Study * Medicare Part D and Medicare Advantage * Medicare Part D Case Study * Medicare Drug Costs* Medicare Part B
* Medical Malpractice__
* Myths and Realities * Malpractice Statistics* Hospitals
__
* Hospital Financial Analysis * Hospital Utilization * Healthcare Expenditures* Fee Index
* Financial Index
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* Pharmacy Financial Index * Pharmaceutical Financial Index * Health Insurance Financial Index * Cost Report Analysis Method* Conclusion
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MY NEW BOOK
_The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda have Exploded Healthcare Costs in the United States_ Can now be purchased on Amazon. Here are the links:Paperback
eBook
NOTICE
If you are interested in attending one of my Medicare seminars, contact me here for moreinformation.
When I began my medical career more than two decades ago, people were already very concerned about the skyrocketing cost of healthcare. However, as much as everyone knew medical costs were high, no one in my profession seemed to know why. None of my colleagues could answer even simple questions about what, specifically, was costing so much. This seemed to be a real problem: how could we begin to control these costs, if even the people in the field didn’t know what they were? Why didn’t we know? To start with, unlike any other business in America, almost all of the financial transactions in healthcare are hidden from the providers as well as the patients. We order tests, procedures and medications to manage our patients, but very few doctors, or other healthcare providers, have any idea how much any of those things cost. Patients only rarely pay directly for these services and payment for any service varies substantially from different payers. Hospitals have separate billing departments that are far removed from anyone ordering or performing tests or procedures. No one directly involved with patient care has any notion of the charge or reimbursement for their service. Even most private doctor’s offices contract billing companies, who just send them a check each month from the total amount collected, leaving them no notion of the actual charge or reimbursement for an individual service theyprovided.
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