Oklahoma Doctors vs. Obamacare
Surgery center provides free-market medicine.
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So Kempton and Smith came up with a cost-saving arrangement: If their employees agreed to be treated at the Surgery Center instead of a traditional hospital, they would be spared the cost of all co-pays and deductibles.
Almost immediately, Kempton was approached by other surgical centers and hospitals. There are now four health care facilities participating in his flat-fee consortium, and more are on the verge of coming onboard.
June Wietzikoski is a typical patient benefiting from this
alternative health care market. She works as a loan officer for a
community bank in Groesbeck, Texas, which is a client of the
Kempton Group. She had carpal tunnel release procedure done at the
Surgery Center for the all-inclusive price of $2,775, which was
covered by her employer. Had she gone to a traditional hospital run
by Integris the discounted bill would have come to about $7,452 and
she would have been personally responsible for the first $5,299,
since she hadn’t met her deductible.
"It makes me mad that people are bankrupted by our current health care system when many times the costs are completely unjustified," says Smith.
Is Kempton's model replicable in other places? There are obstacles. Oklahoma has an unusually entrepreneurial health care sector, which stems from a 1989 decision to roll back the state's Certificate of Need (CON) laws. CON laws, which are still on the books in 35 states, require all medical facilities to get permission from a planning board before opening, which in practice provides a way for traditional hospitals to use political influence to keep new entrants out of the market.
A new provision buried in Obamacare effectively prohibits doctors from starting their own hospitals or expanding the hospitals they already own, which has been widely interpreted as a give-away to the American Hospital Association.
The Surgery Center is exempt from this statue, since it's technically not a hospital and it doesn't accept Medicaid or Medicare. So Smith and Lantier are considering expanding to accommodate their growing clientele.
Smith believes that despite the obstacles, market-driven facilities like his will thrive and proliferate as consumers catch on to costly collusion between big government and big health care.
Says Smith: "Everyone can see what the prices are at the Surgery Center, and that affordable health care is possible. So the jig is up.”
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Video produced, shot, edited, and narrated by Jim Epstein.
Approximately 6.45.
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What are the chances continued success from places like the Surgery Center encourage similar places to open up around the country?
Unfortunately, my gut tells me this place will be seen as a threat and it will meet an unfortunate end, due, at least in part, to government intervention.
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"Nice little 'surgery center' ya got there...."
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And now that the medical establishment has a one-stop shopping locale for all their rent-seeking needs, it's a cinch that they'll find a way to strangle these market-based outlets.
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The surgery center is clearly dangerous because it is "for profit". There is nothing more dangerous than "for profit". The government needs to protect us from these doctors that expect to profit from our injuries and need for doctors. I mean, if they are making a profit, they must be cutting corners and doing dangerous things.
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Chances of these hospitals spreading are very low -- two main reasons. Obamacare bans any new physician-owned hospitals. The other problem is that many states require a "certificate of need" to open a new hospital basically giving current hospitals veto power over any new competition. In Virginia, and other states, not only do you have to get the certificate of need for a new hospital, you also have to get it for a lot of the equipment you would put in a hospital (MRI, radiology equipment, etc.).
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CON was rescinded in OK in 1989. However, medical equipment is pretty tightly regulated, and the ObamneyCare provisions for medical device taxation and regulation is the real bitch.
It's hard to fix the chassis that is the human body without the proper tools.
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CONNNNNNNNNNNNNNNNNNNNNNN!!!
/Kirk
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This isn't a hospital (as near as I can tell). Its an ambulatory surgery center, which are typically separately licensed as such.
It might very by state, but I don't recall ASCs being subject to CON.
Not that the Total State won't find a way to put the clamps on, but I don't think it will be CON.
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You are correct, RC. I had a hernia repair surgery at this place. They had me in and out in a few hours. They also provided me with a "pain ball" which appeared to provide something like 50 hours of local anesthesia to the repaired area. It was almost entirely pain free.
This place rocks!
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I forwarded this to all my friends. Keep up the good work!
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Unfortunately, my gut tells me this place will be seen as a threat and it will meet an unfortunate end, due, at least in part, to government intervention.
I had someone tell me the other day that government-funded health care was a "moral obligation" rather than a "financial obligation" because doctors took the Hippocratic Oath. It seems to me that, in the peculiar place of the liberal mind, providing a for-profit system of health care is in itself a denial of the "moral obligation" (thus immoral) and should be made illegal to protect the community from exploitation. Or something.
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here's a factoid from the Hippocratic oath page...
In a 1989 survey of 126 US medical schools, only three reported usage of the original oath, while thirty-three used the Declaration of Geneva, sixty-seven used a modified Hippocratic oath, four used the Oath of Maimonides, one used a covenant, eight used another oath, one used an unknown oath, and two did not use any kind of oath. Seven medical schools did not reply to the survey.
and sometimes it's helpful to point out this passage from the original Hippocratic oath:
Similarly I will not give to a woman an abortive remedy
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Can be denying the sacrament of abortion, now can we?
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I took a modified HO, and osteopaths also take an oath to uphold the core principles of osteopathic medicine:
-The body is a unit, and the person represents a combination of body, mind and spirit.
-The body is capable of self-regulation, self-healing, and health maintenance.
-Structure and function are reciprocally interrelated.
-Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.
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GM are you a DO?
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Yes, Tonio. I thought you already knew that. I completed an MD residency for surgery, however. Best of both worlds, IMHO.
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I forgot. My memory is far from perfect and I don't have Sug's preternatural abilities to track down anything ever said here. Good for you, though.
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and sometimes it's helpful to point out this passage...
And sometimes it's not, particularly when the discussion has nothing whatsoever to do with abortion; then it's just self-serving bullshit. It's not that you people are wrong, it's that you refuse to let any discussion take place without injecting your pet issue into the conversation; you are why we can't have nice things. DIAF.
Also, the original Hippocratic oath was written by people who didn't know that blood circulated and who didn't know jack about the disease model. So although there is some good in there, there's also some ignorant bullshit:
I will neither give a deadly drug to anybody if asked for it... (IOW, no physician-assisted suicide)
I will not use the knife, not even on sufferers from [kidney] stone... (IOW, no surgery)
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Actually, Tonio, the girl was arguing that adherence to the Hippocratic Oath required government-funded health care. Pointing out that little tidbit would have put a nice troll hole in her reasoning.
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Progressives don't reason; they rationalize.
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Excellent video, but the title is extremely misleading.
The real problem is that nearly all healthcare in the United States is paid for by a third party, whether it's an insurance company or the government, which leads to the massive markups discussed in the video. Obamacare unfortunately does not fix this, it only brings more people into the already broken system.
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^this. Third party pmt is THE issue. Fix that, and the rest starts to self adjust.
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I agree, though I'd amend that to say that first-dollar third-party payments are the problem. We have 3PP in other insurance fields, too, but my homeowner's policy doesn't cover my electric bill and repainting job.
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If car insurance covered oil changes, my $26 trip to Jiffy Lube would cost ten times that or more.
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And, more importantly, you'd pay $10 of it and never, ever know what the final price was.
I've been going to the doc a fair amount lately, and I'm astounded at the cost of things and the byzantine billing practices. I am vowing to price shop it all soon...let's see if any of these providers even know what the price of their services is.
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My daughter was admitted last Friday for breathing problems. No time to shop when the kid's lips are turning blue.
The wife used up the HSA earlier having an ovarian cyst removed.I'll be paying this one off at fifty bucks a month for the next three years.
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Is she okay? Was it new, or is this a recurring thing (e.g asthma)?
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regulated to death in 3.. 2..
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Lew Rockwell recently interviewed Dr. Smith for his show.
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Don't mention the "L" word around here, Tak.
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Do Mention it. They are competitors. Albeit Lew Rockwell is an old fashioned man with a very old fashioned site.
One of the reasons (ha reasons) why I opt this site over his is bc:
a) no comment boards
b) read enough of LR's writers and they will put together some really really poor articles and op/eds. -
Is this a physician owned hospital? Because the ACA goes after those hard. Of if its an ambulatory surgery center, the hospitals fight to restrict what can/can't be done on an outpatient basis.
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Boom. See my 3:33 comment above.
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It is, but does not maintain an ER. That's the big difference. And even though a free standing surgicenter (I matriculated to one after I stopped accepting CMS and is in the process of being bought out when I left the US), it still maintains ties to IBH network and all the surgeons are required to have hospital privileges with nearby hospitals for Level II and III surgeries.
They do the most predictable outpatient ambulatory procedures that don't require hospital stays and accept patients with low risk health HX's.
Their biggest danger, besides ObamneyCare going after boutique medical centers and practices, actually comes from the State of Oklahoma itself by means of the OK Health Care Authority, an unaccountable advisory board appointed for both SoonerCARE (Medicaid), and InsureOK (subsidized employer insurance), and basically forcing the Surgery Center to accept ANY patient as opposed to "cherry picking" patients, since EMTALA does not technically apply here. The other peril posed is one of the big names in OK health, like SJMC or Ardent Health Networks swallowing up these satellite practices via legislation.
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The other peril posed is one of the big names in OK health, like SJMC or Ardent Health Networks swallowing up these satellite practices via legislation.
Agreed. I think that we will see a lot of cash-based alternatives to Obamacare emerging in the next couple of years -- with even more quickly emerging legislation right afterwards to make such places illegal.
I wonder how long boutique practices will be permitted, or anything done outside of the web of ACA-approved health insurance. Remember Hillary Clinton's plan back in the 90s would have made it a FELONY for any physician to provide care outside of an insurance arrangement (thus, you could have technically gone to prison for writing an antibiotics prescription for your spouse.)
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A similar idea here in Canada, with predictable results:
Westbank First Nation hospital likely unconstitutional, says expert
A B.C. First Nation's plans to build a private hospital in the Okanagan will most likely be challenged by the federal government, according to one constitutional expert.
...
"This proposed health facility would raise Canada Health Act concerns if insured persons are charged for insured health services provided there."In other words, "fuck you, go spend your money in the US".
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Soon that will be "...spend your money in Mexico."
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Pretty much. Monterrey is filling up with good quality hospitals and clinics, and it is close to the border...
Isn't entrepreneurship magical?
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Self-funded companies, like individual patients, can negotiate directly with hospitals for lower prices. Recently a handful of self-funded Fortune 500 companies struck deals directly with major hospitals to care for their patients for a negotiated fee.
Are you saying that all of these companies and people working for them do not have health insurance? I thought that is outlawed under Obozocare?
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Don't forget Hyperion, a ton of companies got waivers (remember THOSE?) from ObamneyCare, and can be either extended and rescinded at the will and sole discretion of Sec. Sibelius and HHS.
I imagine as long as these companies' lists of approved coverage mandates are congruent with current diktat, they will very likely keep those waivers in effect.
It's good to have friends in high places, no?
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Thanks, that was the variable that I had forgotten about. I thought though, that those are only temporary.
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I'm 46 and I've never seen a doctor with prices on the wall. About damn time.
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This is actually one of the things the government should mandate. Can you imagine the competition if hospitals had to provide a price list of their services, and the Preferred Provider monopolistic bullshit was eliminated?
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Why do you hate contracts, Rocks?
That's all preferred provider networks are, is contracts between doctors/hospitals and insurance companies, or even plain old companies that self-insure.
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Yeah, with the current system, it is pretty much like this.
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The bill, which is strictly for the hospital itself and doesn't include Sigmon's or the anesthesiologist's fees, totaled $33,505. When Sigmon performs the same procedure at the Surgery Center, the all-inclusive price is $5,885.
The Integris bill for the same nasal procedure went to Blue Cross of Oklahoma, so the patient had no compelling reason to question its outrageous markups. They included a $360 charge for a steroid called dexamethasone, which can be purchased wholesale for just 75 cents. Or the three charges totaling $630 for a painkiller called fentanyl citrate, which all together cost the hospital about $1.50.
Whoa, whoa, whoa. Is Reason seriously implying this is a bad thing? The hospital, being extremely wealthy, will use that money to reinvest and grow the economy. The administrators making $413,000 a year? Those are job creators. This kind of class warfare stuff is NOT something I appreciate.
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Is Reason seriously implying this is a bad thing?
I'd ask if you're an idiot, but that's pretty obvious. It's a bad thing for the CONSUMERS. Healthcare costs are a big concern, especially as our government uses them as an excuse to meddle in our lives. And you can't honestly call approval of COMPETITION, that the government seems to be against by the way, as "class warfare". You're either really stupid, or a REALLY bad troll.
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There are only two classes in society: the makers and the takers. Those hospitals making big bucks? Those are the makers. They're job creators. The people wanting cheap health care? They're the takers stealing the makers' fortune.
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The hospital and administrators are making large amounts of money because of regulatory capture. That would make them takers, not makers.
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Another nice thing about the surgical centers is that they are much more willing to cut you a deal on price than a hospital is. Even though I work in healthcare, I don't have insurance. There are several reasons I won't go into, but suffice to say I've chosen not to have insurance at this time.
Recently, I had an open umbilical herniorrhaphy done at a surgical center. The average price for this procedure is around $8,000 at a surgical center if insurance is paying, and up to $25,000 at a hospital. The place I went wasn't all inclusive, but after haggling with the surgeon, the anesthesiologist, and the surgical center each separately, my total cost was $1,977.
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Nice to know it's there. Since I'm uninsured, if I need non-emergency, routine surgery, I might be taking a trip to Oklahoma.
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"Patients may have no choice
butto look outside the traditional health care industry."FIFY. Because that's where you're going. It's not fair that one person is able to afford more medical care, and not for the obvious "eww, rich people" reason: it is because the care he purchases should rightly have gone to someone else. You see, a child died so that you could have that LASIK done. Because the doctor who did it, he should have been doing something else. We have other jobs for him. So go buy some glasses, and help make sure the glasses factory doesn't have to be shut down. There are lens-grinders whose children are counting on you.
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When I gave birth to my first child in 1972, the hospital bill was about $700, which was for my grad school student husband and myself, about a month's income.
When my daughter gave birth last year, the co-pay was $2,000 and $1,000 had to be paid in advance. Total bill was around $15,000, and that didn't include the prenatal care. $15,000 was around six months' income for them.
Both uncomplicated births, which could have even happened at home, but understandably, medical professionals were on hand just in case of a complication.
I don't see why an uncomplicated birth should cost six times more in 2012 than in 1972. I don't see the Cadillac vs. Corolla comparison here. Basically the co-pay now, adjusted for inflation, is equal to what we used to pay for the whole thing.
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Well, the insurance executives must get their annual bonuses from somewhere.
Contrary to popular belief, doctor's fee makes up a very small fraction of the hospital bill. When you get rid of the middle man and deal directly with your physician (the way it used to be), cost of care drops dramatically.
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The fault lies in the failure to enact tort reform. All those trolling lawyers that send up daytime TV ads are looking for enough complaints to make a class action suit. Medical insurance providers are notoriously shy of publicity and will settle suits out of court more often than not. I knew an OB/Gyn who was sued by a woman who showed up in his office literally days before delivery. She won an undisclosed claim despite the fact that the doctor had ample evidence it was fraud. When you have to have insurance on every provider from the charge nurse to the equipment and even the medical facility, that adds layer upon layer of additional cost. Remember, every fee, every penalty, every tax is ultimately paid by the consumer. This is why Obamacare is such a total fiasco. And this is why the cost of care is skyrocketing rather than dropping.
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Just had a shoulder procedure done at a similar place in Oregon. The surgeon was one of the owners of the surgery center. The total bill is about 1/3 of having it done at the hospital the surgeon is affiliated with. A part of their model is that the clinic does not participate in ANY insurance network, but they accept the payment as if they do. The other thing is when you walk in for your surgery, you better have your checkbook or a credit card. They collect the copay up front. The care was outstanding, personal, fast, and I had a great result. And if you look at the data, these places generally have lower rates of infection that hospitals.
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Any offices in Ardmore or Durant (planned anyway)? Inquiring Metroplexers want to know.
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greater by orders of magnitude
What does this supposed to mean? Two orders of decimal magnitude is "a hundred times"; maybe the hospital charges/collects one (decimal) order of magnitude more than the Surgery Center, but certainly not by two or more orders of magnitude.
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Shut up, you autist.
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As a teacher, whose policy through my school starts Sept 1 every year, I saw the first 15% rise in premiums back in 2011. I saw another 15% this year, along with a $5000 copay.. Every time I have gone to the doctor on top of my copay I get a bill of $135 for an office visit. I have badgered them to tell me the cost of things up front as I am the only one working, but every time we end up paying more. When my doctor told me to get a mammogram I asked the cost. Imagine my surprise to find out that if I used my insurance I would be billed for $311-and be stuck for the whole amount, but if I just paid without insurance, the costs would be $175. I pay over $500 a month for just medical care-we had to drop vision and dental-don't I deserve some sort of break?
The worst case was my newly married daughter's insurance debacle. She had gotten insurance privately through Blue Cross on her own because the policies at her company were not very good and too expensive. Imagine her surprise that as a married woman under the Obamacare mandates, she is covered for birth control, she is covered for abortion, but she is NOT covered for pregnancy. It turns out that NOBODY is writing policies for pregnancy coverage for private insurance policies. So there's your Real War on Women and the Obama view of "reproductive freedom".
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You can't insure against pregnancy.
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No wonder hospitals seems to be gold plated with overpaid administrators. They, along with the big health insurers, are now in bed with government. But being in bed with government is like doing deals with the Mafia. When government starts running out of money, they'll be changing the rules to take money from the hospitals and the insurers, and cutting into their $5000 dollar suits. We've lost our freedom to handle our own health care.
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Similarly I will not give to a woman an abortive remedy.
""&B125;&"" -
To me, it seems that this Oklahoma medical center is voluntarily incorporating they key cost control measures that ACO's are being incentivized to take in Obama's ACA law ("Obamacare"):
http://en.wikipedia.org/wiki/A.....ganizationIf that is not the case, could someone set me straight? (With facts or reasoned arguments, please.)
Thanks,
Mads
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This article clearly shows that while Obamacare is a good start, more needs to be done to remove 3rd-party private insurers from the equation, and The Surgery Center is one example. WhiteGlove Health is another.
Obamacare does include a focus on wellness, prevention, positive outcomes, mandates to cover preexisting conditions, and requirements that 80% of insurance premiums must go to actual medical care, but it still relies on insurance companies that have perverse profit incentives to drive UP the costs of care. Insurers also promote fear of lawsuits and the practice of defensive medicine so they can also sell malpractice insurance, rather than addressing the real problem of medical errors in the first place.
A lot can be learned from medical tourism and innovation elsewhere (see www.mhealthtalk.com/2011/10/innovation-in-india/), and The Surgery Center is an example of innovative ideas here too, with early adopters coming primarily from privately insured employers. Others want single payer universal healthcare, which has worked well for other nations, but how could we deliver that and still encourage innovation and competition? See www.mhealthtalk.com/2012/08/hybrid-model/.
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Here is a web conference I just did with Dr Smith that expands on the ideas he discussed in this video.
http://www.youtube.com/watch?v.....e=youtu.be -
This seems like a brilliant idea. However, to qualify it as "vs. Obamacare" is not only reckless, it's sham reporting. Third-party paid procedures have been around for quite some time.
My only question is why is this not more common?