Comments on: Local Physicians To Discuss Healthcare Reform

By: Tony Brannon

Tony Brannon — Sat, 22 Feb 2014 12:51:01 +0000

Why does every doctor and his mother these days have a lab ? Because there is BIG BUCKS in this labs, and big dollars in imaging – especially when the insurers pay out….and then are premiums keep going up and up and up…..
Then if the lab can’t do it they outsource the test (without telling you ) to the local hospital (or overseas) and then they mark that up a GAZILLION PERCENT % ……
As I say something needs to be done. If an MRI machine costs $ 1,000,000 and the locals are charged as much as $ 8000 then after 125 patients the machine is paid off…. That is a very QUICK repayment. Some MRI machines cost more. THAT said……If 300 MRI tests were done a year, and we say a TWO year repayment window was reasonable then the cost of the MRI should be $ 1,666.00 So round it up to $ 2000 to allow for the staff / operators etc This seems more like the right price.
http://www.kaiserhealthnews.org/stories/2012/december/09/mri-cost-price-comparison-health-insurance.aspx

By: Tony Brannon

Tony Brannon — Sat, 22 Feb 2014 12:37:25 +0000

I will post this AGAIN:
I aint paying a bill that is a RIP OFF>….. 1000% over the cost of a blood test in the USA is unacceptable……..Take me to jail….but I am not getting ripped off by the hospital via my doctor……no way….. PLUS PLUS……they never tell you the costs when you question it they say “Oh you have Insurance DON’T YOU” – That ladies and gentlemen is the problem……UNTIL we have consumer protection and a price WATCH DOG to protect the Patient and the Insurer, the boys in the middle are playing BIG GAMES……

By: Tony Brannon

Tony Brannon — Sat, 22 Feb 2014 12:36:31 +0000

There is nothing wrong with a fair profit……People do not become doctor to not get paid…..BUT the GREED has totally taken over and some doctors have totally sold their souls. There are doctors here I KNOW who are aghast at what went on at KEMH I hope there is a good amount of soul searching today by the local doctors

By: Joan

Joan — Thu, 20 Feb 2014 21:32:49 +0000

So why not put into place guidelines? Why put a layer of bureaucracy in the system in the form of precertification? What if there is a delay in treatment because of the precertification and someone dies? Who is paying for this? What evidence is there that precertification will reduce health care costs? Precertification exists in the USA and it hasn’t helped costs there, it just adds complexity and takes the individual even further away from the care that they need. It’s not just the individual and their doctor, it’s some random third party working off of some “international guidelines.” Why have someone else come between me and my doctor? This looks like it will cause lots of harm!

By: Joanna Sherratt-Wyer

Joanna Sherratt-Wyer — Thu, 20 Feb 2014 21:10:35 +0000

Archie,
I must raise my concerns on a couple of issues. Firstly, let me say that I hope that 100% of tests at KEMH are ordered by physicians, not the 56% you stated.
The Bermuda Medical Doctors’ Association (of which I am the President) represents physicians on the island, and we recognize that the escalating costs of healthcare are totally unsustainable. However, we are extremely keen to avoid pre-certification. The aim of this, as stated by the government, puts mechanisms into place that will requires that doctors require pre-authorization for tests that they request. At the moment, it seems that this is limited to CT and MRI requests, but may well spread to include other services.
The issue here is that this comes at a cost. Someone will have to pay the costs of having a system that can implement pre-certification. Staff will need to be hired – both by the insurance companies and by the doctors, in order to deal with the requisite paperwork. The cost of these tests will be born by the patients – whether in the form of higher premiums, or higher co-pays at the physician’s offices.
Not only are we worried about the costs to our patients, but we are also worried about delays incurred by using such a system, and the legal ramifications that will happen if the test requested is refused. If I order a test on a patient, it is because I truly believe it is a necessary one. If I believe that a patient needs a CT or an MRI scan, and it is refused, but that individual is later found to have a medical condition which could have been treated if caught earlier (such as cancer), then who is responsible?
The government is aiming to save $6 million dollars by introducing pre-certification. They have not declared how much implementing it is going to cost. And to put it in perspective, $6 million is less than 1% of the total healthcare spend in Bermuda (which is over $679 million).
Of course, it sounds appealing – we all want the best in healthcare for our patients, but this is not shown to improve healthcare. The BMDA is much more interested in implementing appropriate guidelines for guiding treatment of patients, ensuring that physicians across the board are giving the best care they can, looking at ways to avoid the unnecessary duplications of tests, and viewing the broader picture of how we can cut costs across the board.
Pre-certification is NOT the same as guidelines – let’s work on improving patient care and cutting our costs in ways that make a material impact across the healthcare budget. As physicians, we want that above all else for our patients. As a patient, I expect most people want their doctors to request the right test at the right time, and to give appropriate and timely care – not to spend their days on the phone/fax to a third party trying to get approval for what they know their patients need.

By: Loquatz

Loquatz — Thu, 20 Feb 2014 20:49:37 +0000

Red herring.

By: Tony Brannon

Tony Brannon — Thu, 20 Feb 2014 20:33:40 +0000

There is a serious disconnect between pricing of healthcare in Europe, UK, Canada, USA & Bermuda. There is a a rampant abuse of overcharging for testing, doctors visits, drugs in Bermuda. Blood test costs at the hospital are outrageous…..1000% more than in the USA in some cases. The doctors, the drug suppliers etc simply pass on the “CHARGE” to the Health Insurance Companies…..who PAY UP. Health Care is through the roof in BERMUDA. People should be freaked out about this. All the Bermuda Health Insurers need to PROTECT their clients from the over charging of doctors and drug stores, by refusing to pay for obscene billings. Plus the clients need to be INFORMED of the fees up front. This “INSURANCE COMPANY WILL PAY” nonsense has to stop, I am not saying ALL doctors abuse the system, but it has gotten OUT of HAND. HEALTH INSURANCE is insane in BERMUDA……Enough is Enough

By: Archie

Archie — Thu, 20 Feb 2014 20:00:40 +0000

As I understand it, precertification never stops a doctor from choosing a patient’s treatment, it just puts into place guidelines which aim to control over-use of certain things like MRI scans. So if a patient has already had two scans, the doctor will be questioned when he/she orders a third for the same person.
From what I have read, there is also nothing to stop a patient going ahead with the treatment, it’s just that they may have to pay the full cost themselves.
I see no harm in that at all. Health care costs are a major issue in Bda – for a lot of people there will come a time when they are not affordable, ie when they retire, unless controls are put in place now.
The building at KEMH is not really the issue here, it is the overuse of tests – a report recently said that 56percent of MRI scans etc at the hospital came from requests by doctors. That is not a sustainable practice.
I am seriously worried about being able to retire here if the cost of healthcare is not curbed. Putting in place guidelines and practices – that already exist in the rest of the world – does no harm.

By: Haters not

Haters not — Thu, 20 Feb 2014 18:39:46 +0000

OBAers will call you a hater, but I heard the same about the good old doctor. I would never go to him for this unethical behavior. On his business letterhead? Not good, is that a breach sending to his patients.?

By: jaybird

jaybird — Thu, 20 Feb 2014 18:02:05 +0000

I too would like my doctor to decide what tests I need, but as a large employer on the Island we have experienced double digit increases in our healthcare premiums for several years in a row, which is simply not sustainable in an economy where revenue growth is anemic.
If we don’t find a way to stem the inflation of healthcare costs very soon then other difficult decisions will have to be made as to how to offset those costs by either paring down the breadth of coverage or lowering personnel costs in other areas.
I’m guessing that most employees would prefer some sort of precertification requirement to facing substantial loss of health benefits or even job loss.

By: Dr. Knowitall

Dr. Knowitall — Thu, 20 Feb 2014 17:28:49 +0000

Dr. West from St. George thankfully is not on the panel.
After the letter I received from him, on his stationery endorsing Nandi Davis, from his office constituency of #2- It would be difficult for the public of trust his instincts.

By: Loquatz

Loquatz — Thu, 20 Feb 2014 16:42:59 +0000

Gov has been making noise re requiring precertification for medical procedures. LOL thanks but I prefer my Doctor to make judgements on what tests I require, not a civil servant.
If there is one item that is driving up the costs of healthcare in Bermuda, it is not the doctors, it is that huge white elephant addition to KEMH whose costs could bankrupt the country.