I work with a population with ludicrously good access to PCPs and care. They still come in for stupid shit. People still need access to primary care, but I think you’ll be disappointed if your measurement is how often they use the ER. IIRC, ER use went up in studies in the post-obamacare period that had some decent controls. Still though, access needs to improve.
Also NPs and PAs can prescribe meds, make care plans for diabetics, treat basic ailments already. Are you talking about independent practice?
NPs/PAs can augment any practice from primary care to advanced surgical specialties, but they shouldn’t be practicing independently. NPs/PAs also have the same biases as doctors. They aren’t going to want to live in bumblerfuck Kansas anymore than MDs/DOs.
You are correct, but also in theory, it should take less $$ to get an NP to practice in the middle of Wyoming than it would an MD. I realize that empirically it probably doesn’t work out this neatly.
Thankfully I don’t work for private equity, but I came close. The terms of the deal were pretty crazy. I would have been paid ~50/hr + a rate for every single RVU I generate. Average came out to be 320/hr, which was way over the market. This was pre-covid before there was a mini-crash in EM pay/jobs in the summer of 2020. I would have been an independent contractor, and there was no signing bonus. Would have made taxes a lot cheaper for me.
At the end of the day the reason I chose not to work at the time there was because the boss was an asshole (he was 2 hours late for my interview for no discernible reason), the ER was dangerous, and I thought my long term prospects were better elsewhere.
Now, the idea of my job paying me more money to see more patients and do more procedures is something I’d never want to do. I’m qualified to do all sorts of invasive procedures and the lines to do/not do a procedure is gray a lot of the time. Furthermore, it would be a huge incentive to pressure families of older people to do a procedure that isn’t within their goals of care.
This kind of setup is becoming more and more common, and I’m not sure what to do about it realistically. What actually constitutes private equity is an issue too. Vast majority of ERs are run by groups independent of the hospital. Is a physician owned group that’s profit oriented OK? IME some are quite reasonable! Others are fucking assholes.
I thought the recipient’s insurance usually paid the donor’s expenses anyway. Any transplant is going to be 6 figures from the recipient, no hospital is going to discourage donation over $3k.
I’m losing my insurance coverage next week and need to decide between COBRA at $600/month or going through the Marketplace. Navigating this is a god damned nightmare, and I’m somewhat competent when it comes to medical /insurance stuff.
I have one drug that I get once a month. It costs somewhere north of $15,000 per dose. It is a must have for me. Literally not a single plan on the Marketplace says it covers that drug. So I can elect a plan and then file an appeal to have it covered and hope they approve, or just go with COBRA for a while for a lot more money.
Do I make the gamble when the wager is my health? Or just accept the fact that being chronically ill in America means I’ll spend tens of thousands of dollars more than my peers every year on insurance and medical stuff. And people wonder why I don’t own a home or have kids. It’s fucking depressing to have to deal with this shit.
You’re not going to be able to keep cobra indefinitely either.
I’d try to time it so I have as much time as possible to play with and make sure my doctors office knows about the insurance change so they can work on the pre-auth well ahead of time
The drug is an infusion, so not something the dr has samples of unfortunately.
Have a 45 day window for COBRA election so there may be some wiggle room to test one of the Marketplace plans then fall back to COBRA. I spoke with the drug company yesterday but they weren’t able to give me any assistance wrt specific plans or companies. Just gave me canned “if you are struggling to pay for the cost of your infusions you may be eligible for income based assistance” type jargon. I then called HorizonBCBS, one of the marketplace plans I’m considering, and wasn’t able to speak with anyone who could help me. Got through to one real person who insisted I need to give him my account number, I explained I am a prospective customer not a current one, and he said “oh we can’t help you, I’ll connect you to a different department”. Same thing then happened and I gave up.
Next dose is in 26 days, about 3 weeks after my coverage is set to change. I will be eligible for 36 months of COBRA which is more than normal, but yea I’m going to face this issue at some point one way or another.
I’m leaning towards going marketplace, filing the appeal on Day 1, and hoping it gets sorted in time. It’s just all such a headache, and could be so avoidable if this country wasn’t such a shit hole.
I think you might need to break this down a little more. Most doctors in America would take their “exploitation” over being the same kind of doctor pretty much anywhere else. I’m sure exceptions exist.
Does your infusion meet common criteria for medical necessity? If there are literally no other treatments for your condition that are covered, then I don’t see how an ACA MP plan could deny a letter of medical necessity from your doctor. Assuming they exempt it, what would your total OOP cost look like compared to cobra?
It’s considered a step therapy by the insurance companies and this is the last step, so they require you to fail every other option before they’ll approve it. I have failed the other options and it was still a fight, but that was 9 years ago. Not sure how switching to a new company will affect it. This is a common problem with biologics. They are so stupidly expensive that insurance will fight pretty hard to not cover them. Unfortunately insurance companies dictate care in a lot of instances, and will go against what the doctors decide is best for the patient. A friend of mine had a hellish fight with this last year and is now trying to get legislation passed that will prevent denial of medically necessary treatments as decided on by the doctors.
I’ve talked about how dumb it is that we pay certain doctors so much less than others. Specifically we pay doctors who do preventative care a lot less and instead focus on paying proceduralists a lot more.
Since I fall more into the “doctor who can do procedures” bucket than not, and the rest of my work is finding people who need procedures and admissions, I get paid very well.
