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    Quote Originally Posted by dirtsniffer View Post
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    If only there was some system where people could be held accountable for their healthcare costs.
    A simple $20 fee to have a chart made up at emergency would eliminate 80% of the unnecessary visits but that'll never happen.

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    Quote Originally Posted by Swank View Post
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    A simple $20 fee to have a chart made up at emergency would eliminate 80% of the unnecessary visits but that'll never happen.
    I’d be satisfied with a skill testing question...
    Originally posted by Thales of Miletus

    If you think I have been trying to present myself as intellectually superior, then you truly are a dimwit.
    Originally posted by Toma
    fact.
    Quote Originally Posted by Yolobimmer View Post
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    guessing who I might be, psychologizing me with your non existent degree.

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    I always enjoyed this story:

    Quote Originally Posted by kenny View Post
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    My wife (property manager) had a meeting with AHS once as her company was working with them on renovating some office space. Her team expected 2-3 people from AHS to discuss some plans. Nearly 25 people showed up including a guy who's main role was to manage plants/trees
    Originally posted by SEANBANERJEE
    I have gone above and beyond what I should rightfully have to do to protect my good name

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    Quote Originally Posted by killramos View Post
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    I’d be satisfied with a skill testing question...
    Haha, that would eliminate at least 70%

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    I remember a specific problem with their spec... That we told them during construction would cost them dearly. 500$ change order to resolve.

    Well a couple years out of warranty i quote it again... About 2g now with wiring after the fact.

    They didn't have it in the capital budget so they continued to make OT calls for 6 months (3-400$ a pop) weekly. Because that was in the budget.

    5-6 sit down meetings with multiple groups of managers to discuss it.

    Probably cost them over 30k. But no money to fix it. Pretty sure the cost per hour in those meetings to discuss and re-discuss the fix far exceeded the piddly repair.

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    Quote Originally Posted by rage2 View Post
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    I always enjoyed this story:
    You should try working with Health Canada. Even more ridiculous.

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    Quote Originally Posted by revelations View Post
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    Any truth to this?

    Attachment 88444
    Well one glaring inaccuracy is that you spend more paying OT then you do to have another full time employee fill those hours. When an employee works OT you don't pay them an extra pension, benefits, insurance, etc. You just pay them double time. It is definitely cheaper to have more OT than to have more employees.

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    Quote Originally Posted by Swank View Post
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    You saved me a lot of typing, I thought I was reading my own words for a minute heh. Doctors don't just order lots of tests to cover their ass, they do it to pad their pockets. Doctors have been caught numerous times ordering excessive tests and also billing for patients they never even laid eyes on, they just add their name to the chart and collect the cash. One was caught and reported for adding his name to a chart for a patient who was dead 2 hours before the doctor even started his shift. That's not just an inefficiency, it's blatant theft and costing us/the province dearly.

    GP's also get paid per referral so they bill to see someone and then refer them to emergency for a little top up on their pay. The number of referrals that don't need to go to emergency is appalling.
    What you describe regarding physician billings for referrals and diagnostic exams is not accurate.

    They do not receive a payment for the tests they order, nor do they get paid when they refer to another doctor. They are paid for the patient visit, and there can be a modifier for time beyond the first 15 minutes. If that same physician refers someone for a diagnostic test, then the fee for that test is paid to the provider of that test - the lab or diagnostic imaging. If they refer to a specialist, then it is the specialist who receives the fee for evaluating that patient and gets to bill for the referral fee, not the originating physician.

    There is no ordering tests to pad their own pockets, as self referral is frowned upon by the College and there are strict rules around this.

    I do agree that there are some who order more tests than others, and that there is a lot of efficiencies that can be found by not duplicating exams or choosing the appropriate tests for the clinical question.

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    "The problem" with AHS (imHO) is that they have hundreds of staff dedicated to #RollingOut new roll outs of program roll outs about roll outs and that zero of these people have engaged in ANY form of patient care in any capacity for more than a decade, if ever.

    It's like having a student EIT holding a clipboard come and tell a welder how to be more careful while welding in brownfield and then get that n00b to write new safety policies & procedures for how to weld safer than safety safe when this useless twat doesn't know the difference between a mobile welding rig and an air compressor.
    Now, while that does happen in industry, the next step is not usually to start filling a building the size of Southport with these EITs and actively promote those who have Masters & PhD's to form committees who then spend millions on the dumbest fucking programs/initiatives/workflows developed by other morons in countries with systems 192° different from ours that then get inflicted upon the industry with ZERO accountability placed upon those who selected the wrong program to not unsolve the problem that didn't not exist in the first place.

    How stupid would that be? Even Shell doesn't do that. I wonder who does, though...

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    Quote Originally Posted by xrayvsn View Post
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    What you describe regarding physician billings for referrals and diagnostic exams is not accurate.

    They do not receive a payment for the tests they order, nor do they get paid when they refer to another doctor. They are paid for the patient visit, and there can be a modifier for time beyond the first 15 minutes. If that same physician refers someone for a diagnostic test, then the fee for that test is paid to the provider of that test - the lab or diagnostic imaging. If they refer to a specialist, then it is the specialist who receives the fee for evaluating that patient and gets to bill for the referral fee, not the originating physician.

    There is no ordering tests to pad their own pockets, as self referral is frowned upon by the College and there are strict rules around this.

    I do agree that there are some who order more tests than others, and that there is a lot of efficiencies that can be found by not duplicating exams or choosing the appropriate tests for the clinical question.
    Then there's my brother with his kids. Shouldn't he have an MRI? Pretty sure he should have an MRI. Come on! She fell off her bike, she could have hit her head, get her an MRI! haha

    Doctors in Canada are WAY more statistics driven, and do not order a bunch of extra tests with low probability. Most people feel they should do more. In Seattle, and the US in general, its the opposite. Pretty sure they were ready to MRI my shoulder when I stubbed my toe. But the US system is by far the most expensive in the world.

    I did get an emergency CT scan in Edmonton a few years ago when I fell at a site and knocked myself out. I was impressed it only took 3 hours.

    The anecdotes of abuse are cute, but a minuscule amount of the "problem", the free rider problem is ancient, but sometimes costs more to police than accepting a certain level. Remember in Arizona, they wanted to drug test welfare recipients. As it turned out, they spent WAY more implementing the testing than they saved by "catching" drug users. in any system, you have the 99% rule. You can get 99% of the results for pretty cheap, it's that last 1% that can bankrupt you.
    GT1R. 8.82@169
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    Quote Originally Posted by Mitsu3000gt View Post
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    ...Further to that, to avoid a malpractice suit, the doctors order lots of testing to be thorough but also to cover their own ass (the doctors also get paid per test they order).
    Quote Originally Posted by Swank View Post
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    You saved me a lot of typing, I thought I was reading my own words for a minute heh. Doctors don't just order lots of tests to cover their ass, they do it to pad their pockets. Doctors have been caught numerous times ordering excessive tests and also billing for patients they never even laid eyes on, they just add their name to the chart and collect the cash. One was caught and reported for adding his name to a chart for a patient who was dead 2 hours before the doctor even started his shift. That's not just an inefficiency, it's blatant theft and costing us/the province dearly.

    GP's also get paid per referral so they bill to see someone and then refer them to emergency for a little top up on their pay. The number of referrals that don't need to go to emergency is appalling.
    I'm a little stunned that people actually think this is true. As xray pointed out, ordering tests does NOT increase what a physician makes for seeing a patient. If you think physicians order too many tests, perhaps you should try shadowing one for a day to see what it's like. There will always be a few bad apples in the bunch, but in general physicians here are much better at ordering what is required and backed by evidence compared to a system like the US.

    GP's don't get paid per referral, nor do they get paid per prescription, which I've heard many times before. In fact, doing a referral for patient on a day where a patient wasn't physically seen, means doing work for free because there is no compensation for that. It's the same for when a physician reviews labs/investigations and does not see the patient/call them that day. It's unpaid work but it's absolutely mandatory.

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    Quote Originally Posted by oilerfan4lyfe View Post
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    I'm a little stunned that people actually think this is true. As xray pointed out, ordering tests does NOT increase what a physician makes for seeing a patient. If you think physicians order too many tests, perhaps you should try shadowing one for a day to see what it's like. There will always be a few bad apples in the bunch, but in general physicians here are much better at ordering what is required and backed by evidence compared to a system like the US.
    I have literally had ER doctors tell me that themselves, so unless they lied to me, I believe that to be the case. My GF is also in mid-level management in an Emergency department and tells me the same thing with regards to how it works for them. If different types of doctors or areas of the Hospital operate differently, I wouldn't know.

    I don't think doctors order too many tests, but I do think they are incentivised to be extra thorough for a variety of reasons, mostly good. Personally I would appreciate that as a patient - better that than miss something.

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    Quote Originally Posted by Mitsu3000gt View Post
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    I have literally had ER doctors tell me that themselves, so unless they lied to me, I believe that to be the case. My GF is also in mid-level management in an Emergency department and tells me the same thing with regards to how it works for them. If different types of doctors or areas of the Hospital operate differently, I wouldn't know.

    I don't think doctors order too many tests, but I do think they are incentivised to be extra thorough for a variety of reasons, mostly good. Personally I would appreciate that as a patient - better that than miss something.
    The ER docs don’t get paid for the imaging or labs that they order. Diagnostic imaging done in hospital is contracted to the radiology group(s) interpreting those exams. There is typically a professional fee negotiated for each exam performed and paid to the radiology group.

    Same is true in the community. There is a fee code for every imaging exam performed, which is billed by the interpreting radiologist as the service provider.

    Or is your comment directed at the ordering of tests to avoid liability?

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    Quote Originally Posted by xrayvsn View Post
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    What you describe regarding physician billings for referrals and diagnostic exams is not accurate.

    They do not receive a payment for the tests they order, nor do they get paid when they refer to another doctor. They are paid for the patient visit, and there can be a modifier for time beyond the first 15 minutes. If that same physician refers someone for a diagnostic test, then the fee for that test is paid to the provider of that test - the lab or diagnostic imaging. If they refer to a specialist, then it is the specialist who receives the fee for evaluating that patient and gets to bill for the referral fee, not the originating physician.

    There is no ordering tests to pad their own pockets, as self referral is frowned upon by the College and there are strict rules around this.

    I do agree that there are some who order more tests than others, and that there is a lot of efficiencies that can be found by not duplicating exams or choosing the appropriate tests for the clinical question.
    Yeah I'm not sure where this guy got his info from lol. Also when it comes to ordering medications and prescriptions the two parties are separate so that the prescribing doctor does not make money from the medicines they prescribe. I think people are bringing up stories from the American system and somehow conflating it with AHS. I actually do some work in the medical industry and there is a a lot of research carried out in order to make care more efficient, which unfortunately the funding for is being cut. What I've read is that a lot of the inefficiencies are the fault of citizens who use the service when they don't need to ask for things when they don't need it.

    I.e. going to the doctor/ER when they have a cold instead of waiting for it to pass.
    I.e. people asking for antibiotics when they have a cold even though it's a viral infection and not bacterial
    Last edited by gatorade; 12-11-2019 at 02:43 AM.
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    I dont know anything in this matter, but i can vouch for xrayvsn as he is OG and is a professional in the medical field.

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    Quote Originally Posted by Team_Mclaren View Post
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    I dont know anything in this matter, but i can vouch for xrayvsn as he is OG and is a professional in the medical field.
    I'm agreeing with xrayvsn, I'm referring to swank or anyone else who believes the high cost of health care is due to practitioners ordering unnecessary tests or referrals. It is actually patients (us as citizens) who deserve the brunt (and the government) of the blame. Individual doctors don't have the power or footprint to do that, they don't set policy. Any examples of doctors practicing fraud are outliers and are insignificant to health costs when you consider the budget is in the billions whereas fraud from an individual doctor is in the thousands.
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    Quote Originally Posted by revelations View Post
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    Thats not true - our 2 week old was taken to Childrens via Ambulance specifically because he could get in faster (as mentioned by the EMS techs). Zero waiting - and there was a big lineup.
    As the resident paramedic here, I'll just go ahead and tell you that's untrue. I've taken many to the childrens and put them in the waiting room because they weren't sick enough to be seen first. Its always sickest seen first.

    Edit: I saw afterwards you doubled down on this with some sort on enroute triage so I'll clarify some more: We are not part of the hospital system, we do not influence the decisions of triage, they decide where you go and how fast in the hospital. There is no enroute triage, outside of what I use in my decision making. Sure, there's an element of the story I tell on arrival that will result in some influence, but we don't embellish because we have to do this all the time and we work in a trust based system (ie: they have to trust our diagnosis and treatment plans to help them make a decision, because an incorrect one for them is no skin off my back but could be bad for them).

    And its not EMS techs, its Paramedic. We have a regulatory college, I carry malpractice, I went to school for 4 years, I make independent treatment decisions . It would be nice if people would at least seem aware that its more than just driving an ambulance around and driving people to hospitals!


    Otherwise, ask me anything about the prehospital EMS system and how we operate and what we do!
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    Quote Originally Posted by TurboMedic View Post
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    As the resident paramedic here, I'll just go ahead and tell you that's untrue. I've taken many to the childrens and put them in the waiting room because they weren't sick enough to be seen first. Its always sickest seen first.

    Edit: I saw afterwards you doubled down on this with some sort on enroute triage so I'll clarify some more: We are not part of the hospital system, we do not influence the decisions of triage, they decide where you go and how fast in the hospital. There is no enroute triage, outside of what I use in my decision making. Sure, there's an element of the story I tell on arrival that will result in some influence, but we don't embellish because we have to do this all the time and we work in a trust based system (ie: they have to trust our diagnosis and treatment plans to help them make a decision, because an incorrect one for them is no skin off my back but could be bad for them).

    And its not EMS techs, its Paramedic. We have a regulatory college, I carry malpractice, I went to school for 4 years, I make independent treatment decisions . It would be nice if people would at least seem aware that its more than just driving an ambulance around and driving people to hospitals!


    Otherwise, ask me anything about the prehospital EMS system and how we operate and what we do!
    Then I am confused.

    Back story:

    Our 2 week old was having trouble breathing (went red and then borderline blue) and the paramedics were called.

    His condition was stabilized at our house (nothing obviously wrong, he could have spat some milk up and swallowed wrong?) and he was acting and breathing fine - but they advised to take him in to Childrens Hospital anyway.

    They offered a ride in the ambulance but I said thats fine I can drive - plus no need to tie up resources and a 400$ bill.

    The Paramedics said he would get in quicker and that there was quite a wait at that time at Childrens.

    Wife went in the ambulance and I drove to Childrens.

    By the time I got there (prob 10 min after the ambulance) , the emerg admitting line up was almost out the door but my wife and son are already in an exam room waiting for a Dr.
    Last edited by revelations; 12-11-2019 at 04:47 PM.

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    Quote Originally Posted by revelations View Post
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    Then I am confused.

    Back story:

    Our 2 week old was having trouble breathing (went red and then borderline blue) and the paramedics were called.

    His condition was stabilized at our house (nothing obviously wrong, he could have spat some milk up and swallowed wrong?) and he was acting and breathing fine - but they advised to take him in to Childrens Hospital anyway.

    They offered a ride in the ambulance but I said thats fine I can drive - plus no need to tie up resources and a 400$ bill.

    The Paramedics said he would get in quicker and that there was quite a wait at that time at Childrens.

    Wife went in the ambulance and I drove to Childrens.

    By the time I got there (prob 10 min after the ambulance) , the emerg admitting line up was almost out the door but my wife and son are already in an exam room waiting for a Dr.
    Before anyone else gets any ideas about skipping lines at hospitals, let me be very clear; Ambulances do not get in faster. You only need to look at the lineups of crews at the hospitals to see that. If patients are extremely minor, they'll go to the waiting room like anyone else would, even if they came in in an ambulance. If they still need treatment and observation and the department is full, they get parked with us. There is a triage system called CTAS, that determines the order people come in to be seen. Its likely the waiting room had a bunch of CTAS 4-5, and your issue may have been a CTAS 2, I wasn't there, I don't know the circumstances. But flat out 120% there is NO preference given to a patient taken in an ambulance. Heck its taken me over 30 minutes at times to even speak to the triage nurse after I arrive

    Edit: link to CTAS just because: https://www.google.com/url?sa=t&rct=...R_3jQdYmARpvmZ
    Last edited by TurboMedic; 12-11-2019 at 08:02 PM.
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    Thats my point - we WERENT CTAS 2 by any stretch, perhaps 4 or 5. All vitals were normal at that point. There was no urgency.

    However, straight in from the ambulance area into the Dr. exam room.

    The need to even go to the hospital was questioned at the time and we went because the paramedics suggested a ride.
    Last edited by revelations; 12-12-2019 at 12:17 AM.

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