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To: LindyBill who wrote (194513)	1/28/2007 1:08:35 PM
From: skinowski	Read Replies (1) \| Respond to of 794009

I don't see it this way. Hospitals - to my knowledge - have some 5-6 or more employees per bed. That's several daily salaries that each "bed" must pay - and very often only a fraction of those beds are occupied. Otoh, the Dr. will get $100+ for the initial evaluation, and some 60 buck or so for a follow up visit. Add consultant's fees when applicable, and the professional fee part of the procedures -- and it will still be just a small fraction of the overall cost. In a nursing home the Dr. will see the patient once a month or so, and get paid the "allowed" fee for the visit. But the total costs are several K's per month. HMO's? Forgedaboudit. They are immune from malpractice litigation. They'll never tell the patient - or the Dr. - NOT to do a certain procedure. They will merely refuse to PAY. The patient and the Dr. are most welcome to do any and all procedures they deem medically necessary - HMO's don't stop them (and therefore are not liable). My guess would be that HMO's actually increase opportunities for malpractice lawyers. The moment the Doc holds back on a procedure or a test based on cost considerations, he is exposed.

To: LindyBill who wrote (194513)	1/28/2007 1:37:36 PM
From: KLP	Read Replies (1) \| Respond to of 794009

Have you had a Hospitalist Doctor? I did when I had pneumonia last year....He was a Doc specializing in Internal Medicine, who became sick of the pressure of regular practice. The high cost of office staff salaries, the costs of renting the space, the costs of dealing with either a lab on site, or having patients go to a special lab, having office costs that actually cost (pick a number), and having the Government say they would pay a "Percentage of a much lower number" if the patient is on either Medicare, or heaven forbid, Medicaid. This Doc has chosen an 8 hour day rather than a 12+ hour day, and MUCH less expense from having his own office and staff. He probably clears more money this way. Another cost of medicine to the consumer. ANYONE who has to go to the hospital for any reason, is paying also for any person who has gone to ER or admitted, and doesn't have insurance. Definition of Hospitalist medterms.com Hospitalist: A hospital-based general physician. Hospitalists assume the care of hospitalized patients in the place of patients' primary care physician. The term "hospitalist" was first introduced in 1996 by RM Wachter and L Goldman to describe physicians who devote much of their professional time and focus to the care of hospitalized patients. In the most prevalent American model of hospitalist care, several doctors practice together as a group and work full-time caring for inpatients. Hospitalists are familiar figures. Doctors specializing in intensive care have long taken care of patients admitted to the ICU by primary care doctors; geriatricians working in nursing homes have often admitted patients to the care of their hospital-based colleagues; etc. "Thus," notes HC Sox, "the hospitalist model (of care) is not new (in the U.S.), but it is growing rapidly as a result of the role of managed care organizations, the increasing complexity of inpatient care, and the pressures of busy outpatient practices." References Wachter RM, Goldman L. The emerging role of "hospitalists" in the American health care system. N Engl J Med. 1996;335:514-7. Sox HC. The Hospitalist Model: Perspectives of the Patient, the Internist, and Internal Medicine. Ann Intern Med. 1999;130:368-372. The Annals of Internal Medicine issue of 16 February 1999 contains an excellent supplement devoted to "The Hospitalist Movement in the United States."