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Amazon Health-Care Move May Be Next 'Home Run' Like Cloud Services
Amazon.com Inc.'s foray into health care won't be the first time it has disrupted an entire industry by starting with an effort inside the company.
Amazon Chief Executive Officer Jeff Bezos is teaming up with fellow billionaires Warren Buffett and Jamie Dimon to revamp health care for the 2.4 million workers and dependents of the companies they run. The move fostered widespread speculation the trio will eventually make their approach to medical care available to companies far and wide.
Bezos has a long, increasingly successful, record of starting new businesses on a small scale, often for the benefit of his company, then spreading them to the masses -- creating a world of pain for incumbents. Consider the ways Amazon is changing industries as varied as product fulfillment, cloud computing and even the sale of cereals, fruits and vegetables.
This is just a cheap excuse to follow up on the machinations of the world's richest human:
Amazon, Berkshire Hathaway, and JPMorgan Chase to Offer Their Own Health Care to U.S. Employees
(Score: 2) by All Your Lawn Are Belong To Us on Friday February 02 2018, @01:47PM
Plumbers, electricians, and mechanics generally don't have an insurance system which requires submission of discrete codes to categorize their work. They generally do not have to order diagnostic tests that others will perform for any given episode of care.
If they themselves deal with insurance at all (not likely, by the way, except for auto mechanics,) they price out an estimate and ship that complete estimate off. They don't get to tell the insurance company, "yeah, we'll charge somewhere between 3 and 5 hours to fix that plus $200." Auto mechanics, like physicians, have to tell the insurance companies exactly how much the bill will be before work commences.
It's relevant because your outpatient physician has a series of discrete codes they charge. For nominal office visits there are five levels of visit that can be charged. There are lots of rules of thumb about it, but it's basically what I said above - how much work will the physician (and other staff) go through for the care episode. All of this is necessary because of insurance. Doctors would LEAP at the chance to charge you a Level 5 visit every time, instead of having other people look at the work they did and assign a relative value. That won't happen, because the insurance companies won't let it.
Every repair industry has a process for what happens if other things go wrong and beyond their estimate of what's up. But it goes beyond just "we don't know how the body works entirely." It also works off the principal of doing the least amount of work *on average* to cure a given set of symptoms. You come in with an infection. The physician looks at it, checks temp and other vital signs, and makes a best estimate of your condition. He *could* order a culture to be taken (that has happened to me,) but most of the time he knows if he prescribes Antibiotic X (or gram postitive/negative combination antibiotics X+Y) his patient will get better 90% of the time.... or he suspects you may just have a virus infection and decides to not prescribe anything but OTC symptom control because he doesn't want to be wrong with the bacteria and make the possibility of creating a resistant strain. He doesn't order the culture because knowing exactly which organism it is very rarely affects the course of treatment.... the times when it does, he orders the test. Now if he'd ordered that test, he'd could definitively what he should do (though that may take hours to days to get a result)..... but then he's accused of ordering "unnecessary" tests. High quality, low cost healthcare is a game of average, not specific cases... which really sucks if you're the individual patient but few people care about that. Your doc could test if you'd be a candidate for a particular side effect, maybe, but again he won't unless that side effect is a fatal condition occurring in enough cases to be a problem.
So.... what the hell should the bill be IF you have that situation. Hospital billing is ENTIRELY DIFFERENT. Instead of charging on the services performed, a hospital will take the sum total of your diagnoses, issue a diagnosis-related Group code and bill based off that complex. "Aha!" you think - that's the ticket! But remember that we need to know your final diagnosis before that code is settled upon. Come in with a hangnail for observation... actually you'll get billed by the outpatient rules because reasons.... but once you're in the hospital unless you leave against medical advice you're going to be diagnosed as accurately as possible because the hospital will ultimately be paid based on what you actually had happen. Which is why hospitals have in-house labs and diagnostic services and all that. And if your condition worsens.... your diagnosis changes. Surgery is a little different because your surgeon will be their services as outpatient services (I did X, pay me for what I did) while the hospital still bills the diagnosis complex for their care.
Because of this, no they won't check if they quoted for a cardiac arrest. Come in with an infarction (or develop one) and your diagnosis codes change to handling the code. All the labor, materials, etc. are covered. And you pay a HELL of a lot more than if it happened at your Doctor's office, the medics come, and you're pronounced at the scene.
So, do you want the current system where it feels like you're being screwed, or do you want a system that doesn't operate on averages and you pay some multiple of that more? Because medicine ain't plumbing, or car repair, or electrical, and any system where you'd be paying flat quotes would drive the price up, not down.
This sig for rent.