Certificate of Need Laws: Updates and Paths Forward - M. Todd Rice, MD, MBA

[@calvinsmyth]

The hospital bills for CRNA services. That $2K bill you mentioned is paid to the hospital with the CRNA staff receiving their hourly pay and a small percent of their benefits from it. The hospital keeps the lion's share for supplies, monitoring, overhead, etc....The anesthesiologist who contracts wlth the hospital gets most, if not all, of that $2K for their time. They negotiate their fees with the hospital. Doctors/surgeons along with the hospital administration drive the costs of healthcare up. Having worked in hospitals, day surgery centers, and a doctor run/owned clinic, there is a notable difference between the three facilities regarding level of safety, cleanliness, education, and experience of the staff with the doctor owned/run clinic being at the bottom.

[@m.toddrice8134]

As the presenter here, and an anesthesiologist with wide experience across private practice, academic practice and employed practices, it is important to note that each of these practice models generates its billing differently. Private practice is typically an independent group that contracts with the facilities to offer services but does not receive money from them (although they might receive a "stipend" from the hospital if that has been negotiated). The private practices directly bill third party payers and will be paid according to that negotiated amount, regardless of bill (which will always be inflated to attempt to keep the negotiations from being driven lower). Employed and academic anesthesiologists receive nothing of a generated bill. In those instances, we are merely salaried. All recovered funds go to the institutions. Regarding the CRNA billing, equally, they will get a salary, just like the employed physicians. The facilities already charge a "facility fee" and bill out the supplies and drugs separately, so that bill can be difficult to justify, as well. As well, I've worked and work in all of the mentioned settings. Each can have problems, but certainly one of the main points of the presentation is that the massive corporate institutions, in league with the regulatory capture provided by government constraints, and also in conjunction with non-transparent third party payers, drive up costs to astronomical levels while acquiring or driving out independent practitioners. My example of Keith Smith's Surgery Center of Oklahoma is a pioneer in cutting out all of the hidden bloat, posting bundled and low pricing transparently on the website, and providing personal and quality driven care - not that determined by a government body, but rather by human beings that are the patients. A great aspect of competition is that if a patient decides a physician-owned facility is "at the bottom," per your experience, they can take their business elsewhere, post a review on Google, and support another facility or doctor. When one's insurance mandates a particular facility in order to receive full "coverage," that free association is altered, as well as the pricing mechanisms that drive the bills down and the quality up for the consumer/patient. Certificate of Need is merely one barrier in the convoluted Managed Economy of Big Medicine. My attempt is to find healthcare delivery and pricing models that are more transparent, honest, moral and competitive. Direct Primary Care and transparently-priced surgery centers are doing that. Kudos to them!

[@Oldmanwithagoldpan]

Says there are four comments, I can only see mine. That's not censorship at all. Good thing we're really free.

[@annaaurora81303]

11 comments, four posts 🤯🙄

[@Oldmanwithagoldpan]

A Public Comment.

[@Oldmanwithagoldpan]

Government Control guud, Corporate Control of government Guuder! Mmmmkay. 🥴