bshep (u/bshep) - Readit News

bshep commented on The fight between doctors and insurance companies over 'downcoding' nbcnews.com/health/health... · Posted by u/ceejayoz

lesuorac · 5 months ago

Sure but imagine you hire a landscaper and they send you a $40 invoice for $20 of law cutting and $20 of leaf cleanup. You go look outside and see a ton of leafs so you just send them $20.

That's the insurance companies' stance. The work you performed is this and so our agreed upon rate is this.

bshep · 5 months ago

but the landscaper has a photo of the clean yard after they finished. They send it to you but you ( as the insurance company) say they need to call a specific time and speak to your 12y/o who is the yard representative of the house.

The 12 y/o say ‘no you stink’ and hangs up. Then you send the landscaper a letter saying ‘sorry your peer to peer was denied’

( I know this is exaggerating a bit and made to sound funny but it mostly works like that in healthcare )

bshep commented on It's just a virus, the E.R. told him – days later, he was dead nytimes.com/2025/10/05/we... · Posted by u/wallflower

tayo42 · 5 months ago

Do doctors do extra hours per week? I thought they work less days but do this crazy long shifts

bshep · 5 months ago

sometimes, but extra hours dont get paid extra, so very little incentive to do so. there are many different models for compensation but you can think of it as a 'fixed salary with optional bonuses'.

EDIT to add:

Most places have a base + bonus structure. You get your base salary, and you see patients, for each patient seen you generate 'RVUs' which is how your group/practice generates income ( by billing insurance companies ). Once you generate enough RVUs to cover your base salary, you start accumulating 'bonus' and that gets paid out down the line using whatever formula your employer uses. There is some variation to this but for the most part groups follow a similar scheme.

EDIT #2: This is US centric, i dont know how other countries do it.

bshep commented on It's just a virus, the E.R. told him – days later, he was dead nytimes.com/2025/10/05/we... · Posted by u/wallflower

toast0 · 5 months ago

> The demand is just short of infinite, it requires an extremely specialized and highly capable labor force, and it has piss poor labor productivity forever.

Just because demand (typically) outstrips supply doesn't mean demand is just short of infinite. It just means it's hard to measure the demand. This is just like highway traffic --- you can't know what the demand is when it's all full, you just know there's more demand than capacity/supply.

If you built a crap ton more hospitals, and forced everyone into mandatory service in healthcare for 20 years, I'm sure you'd have more supply than demand. That's a terrible plan, but it would solve the supply problem. You could modulate the mandatory service period to adjust to the needs, and it would still be a terrible plan. :)

Something better would be some steps to address the bottlenecks. How can we attract / train a larger labor force; how can we retain the labor force; how can we increase productivity; something about facilities. Who can make the changes and how can they be incentivized to do it.

I'm outside of healthcare, but here are some armchair ideas. There's a lot of "administrative busy work" that makes everything harder to do; if you ever need to call around to multiple pharmacies to get your meds, there's two problems there: the first problem is that shouldn't need to happen, the second one is that it's amazingly difficult for pharmacies to communicate; it's not uncommon for a physician to order a test and the wrong test is performed, etc ... it's not easy to streamline communications, but it would improve productivity if done correctly. There's also a lot of things that reduce quality of life of healthcare professionals which reduces desire to go into the field and reduces time spent in the field. And of course, there's limitations on the number of residency spots.

bshep · 5 months ago

The pharmacies issue is a constant problem: patient lives out of town so prescription is sent to his home pharmacy at his request, on the day of discharge he realized his pharmacy is closed and wants them sent to a local pharmacy, of course this always happens at 5pm when you are driving in traffic, the patient is angry because they want to leave but there is not much you can do. This happens very frequently, doesnt matter if you ask ahead of time for the patient to confirm the pharmacy, something inevitably happens.

The other issue is peer to peers and prior authorizations, these take up a significant amount of time and are essentially ways the insurance companies put barriers to care and reduce their costs.

I think some of your ideas could work but good luck getting anything past the politicians, some of these things would be expensive and others would be unpopular to those that donate to the politicians.

bshep commented on It's just a virus, the E.R. told him – days later, he was dead nytimes.com/2025/10/05/we... · Posted by u/wallflower

yjftsjthsd-h · 5 months ago

> more shifts for docs = more $$ paying for more medical staff.

I don't follow. It can't be more expensive to pay 2 doctors for 8 hour shifts than 1 doctor for 16 hours; if anything, I'd expect it to be cheaper (no overtime).

> but there have been a bunch of studies that showed that handoffs between shifts at hospitals is where things go bad. Someone doesn't document they gave an extra 2 cc of a drug to a patient, and next shift gives them more and causes issues, etc.

Hence pushing for checklists so that doesn't happen?

bshep · 5 months ago

The docs dont get paid per hour, they are salaried, so 2 docs is double the cost of 1 doc.

This is why they are overworked, why pay 2 docs if 1 can do the work, the burnout of the doc is irrelevant as there are more docs to hire after they burn-out.

bshep commented on Futurehome smart hub owners must pay new $117 subscription or lose access arstechnica.com/gadgets/2... · Posted by u/duxup

bshep · 7 months ago

This is why if you have a choice you should buy devices that have ‘local only’ option.

Unfortunately the masses dont care or dont have the technical knowledge to taoe advantage of it

bshep commented on MTA Open Data Challenge new.mta.info/article/mta-... · Posted by u/oftenwrong

chaps · a year ago

I do work with "open data" on a near-obsessive basis and -- friends, please do not trust "open data" portals to reflect reality accurately. The datasets are often curated, categories changed during the ETL processes, rows missing, and things like that. For example, Chicago's "crimes" dataset intentionally doesn't include all homicides. Can't remember the exact dataset, but I once had a conversation with Chicago's head of open data who told me that they intentionally removed many rows because they were concerned that the public was going to misinterpret the results... but didn't make it clear that rows were missing. So I guess everybody gets the opportunity to misinterpret the results!

FOIA is the better alternative because it gives you the original, pre-cleaned data. Open data is a lie.

bshep · a year ago

Where I grew up the data for murders is curated in such a way that anybody that dies 24 after being attacked is not considered a ‘murder’. Tehy do this to reduce the statistical murder rate.

bshep commented on Hackers may have leaked the Social Security Numbers of every American engadget.com/cybersecurit... · Posted by u/dataflow

donatj · 2 years ago

The small private college I attended in the early aughts used your SSN as your student ID and it was printed on everything. Transcripts, official records, basically any piece of paper with your name on it. You'd even speak it aloud to the worker at the book store to pick up your books for the semester. It was everywhere.

As a kid twenty years ago, I was mildly bothered by it but imagined they must know what they are doing.

Looking back at near 40, with the hindsight of years, I'm flummoxed. Like, what the hell, who's absolutely terrible idea was this?

bshep · 2 years ago

Slightly related, my uni id was a prefix for the campus + year of admission + serial number

the serial number was sequential based on last name, you could essentially guess anyones student id if you had a couple of data points of last name : serial number

As far as I know no one used it for nefarious purposes, but it was a cool party trick to guess someone’s number.

bshep commented on The darker side of being a doctor (2017) drericlevi1.substack.com/... · Posted by u/fadali

metalcrow · 2 years ago

> you can get sued for patient abandonment if you refuse to followup on a patient you are responsible for

Sure, but that isn't the case in this linked article, it seems. Being on call for emergencies, doing elective surgeries, refusing to do that doesn't count as patient abandonment as i understand it. Only when you are actively taking care of someone can you not leave them.

> in part yes there are ( in some fields) but what would happen is that patients would be shifted to other facilities that have staff to see the patients, also when you have 400-500k of school debt its hard to refuse work

Ah, yeah then that's the main problem. There's such an excess of supply that hospitals can afford to treat doctors like crap. Same idea Amazon has about its workers. In that case, hopefully articles like this will make people realize becoming a doctor is a bad choice, and reduce the supply and allow stronger employee bargaining positions.

Of course stronger regulations would always be a better option for this case, but i don't see that happening.

bshep · 2 years ago

You are correct in your points.

In the end I don't know where the solution lies, sometimes I feel the best solution is to re-design everything from the ground up. Other times I feel like regulation would help, but it would have to come from someone who practices actual medicine, bureaucrat.

bshep commented on The darker side of being a doctor (2017) drericlevi1.substack.com/... · Posted by u/fadali

metalcrow · 2 years ago

It seems to me the only way to fix this problem, aside from some sort of large regulatory changes by the government, is for doctors to start unionizing or striking to force better conditions. What would happen if doctors simply refused to do more then 60 hours a week? Is there really enough supply of new doctors coming in that the hospital can just fire them all and replace them with doctors willing to burn themselves out? Or would it mean the hospital would have no choice but to hire additional doctors so that each one would only have to work a sustainable number of hours?

bshep · 2 years ago

What would happen if doctors simply refused to do more then 60 hours a week? -> you can get sued for patient abandonment if you refuse to followup on a patient you are responsible for

Is there really enough supply of new doctors coming in that the hospital can just fire them all and replace them with doctors willing to burn themselves out? -> in part yes there are ( in some fields) but what would happen is that patients would be shifted to other facilities that have staff to see the patients, also when you have 400-500k of school debt its hard to refuse work

Or would it mean the hospital would have no choice but to hire additional doctors so that each one would only have to work a sustainable number of hours? -> this happens as well, they hire locum tenens docs to fill in gaps ( higher short term expense in exchange for not giving staff docs what they need)

bshep commented on Riven filfre.net/2024/05/riven/... · Posted by u/doppp

tomxor · 2 years ago

Is there some kind of trick to getting the CDs to load? I've tried Firefox and Chromium, nothing seems to happen on either when clicking on the CDs, no console errors.

bshep · 2 years ago

no really, you click on them and they show up... i'm not sure why it isnt working, they load up from archive.org so maybe its a block in your country?