Wouldn’t it be nice if we could just practice evidence based medicine and our patients could just get the medications they need?
948
u/unaslob
How bout the pts that show up third week of December looking for you to arrange their echo, stress and colonoscopy (that you recommended in April) before end of year because they met their deductible. ‘Well I’m not going unless you can get it done next week’ as if they are punishing me.
360
u/Interesting_Owl7041
My dad just went to the pharmacy to pick up his Mounjaro, which he is prescribed for his longstanding type 2 diabetes. They wanted over $1300 for a 3 month supply. My dad is 83 years old and on a fixed income, but he’s over the income threshold where he would receive any financial help. He called the insurance company to double check and they told him that the price was correct, he has to pay $2000 out of pocket for the year and then insurance will cover it for the remainder of the year.
This is a problem. I understand that it may not be saving any money if it’s distributed more evenly throughout the year, but paying over $1300 in one fell swoop is not easy for many people. $2000/12 months is about $166/month. That’s a significantly easier bill to cover for most people.
220
u/microcorpsman
Obfuscation is the weapon of the financial class.
People don't understand their effective tax rate either, or their refund being big means they over paid, or how leasing a car fucks them over, or how their brokerage doesn't actually have a fiduciary duty to them and is charging them out the ass
174
u/janewaythrowawaay
Depends.
Whenever I’ve had surgery and asked a certain hospital group for a payment plan they’ve written off my bill. They didn’t report this back to the insurance company or if they did, they didn’t adjust my deductible back down.
Also, with some very expensive meds the pharmaceutical company coupon/charity assistance covers your deductible if your state hasn’t closed the loophole.
So, no it’s not a situation where you always have to pay your deductible and may as well get it over with. Even if the hospital doesn’t write it off they may bill something like $50 a month affordable to a low income person.
The person may simply not have an extra $300/month for the med period.
129
u/ShelbyDriver
Cross post this in r/pharmacy . They'll know.
52
u/trainrover
Insurance is such a scam, I dunno how Americans are okay with this.
42
u/moonsion
Oh yeah as an Ortho we have shit ton of patients all wanting their surgeries done in December. Because then they would have "met the deductible so the surgery would be 'free', and will be resting at home during Xmas allowing the wound to heal better."
Well, guess what? Everyone is thinking that, and I want my vacation in that time of the year as well.
41
u/Cautious-Extreme2839
I don't understand how the existence of deductibles is tolerated in health insurance?
No other type of insurance has an annualised excess - it's per claim only. Which I think is what you guys call a co-pay?
What I mean to say is that even for a private insurance based system - the American system seems to be extra fucked up.
33
u/CaptainAlexy
High deductible plans should not exist. It’s essentially a scam that only pays out if you have a catastrophic claim.
31
u/Ratleo
European here.SGLT2 (dapagliflozin) costs 36.31 Eur a month without insurance. If you have health insurance, you end up paying around 6 Eur/a month. You guys really live in a third world country
25
u/thlaylirah17
Medication copays have to be paid up front at the pharmacy. If you can’t pay, you don’t get your prescription. The bill for the knee replacement can be put on a payment plan.
I agree with you the whole system is fucked, just explaining why someone can “afford” to hit their deductible through medical claims vs not being able to afford it through pharmacy claims.
23
u/DocMacgyver107
One of the skills I've had to learn in rural primary care was how to get good meds for my patients for reasonable prices. SGLT2? BRENZAVVY from MarleyDrug.com or costPlus Pharmacy for $60/mo, half if you cut the pill. GLP? Generic liraglutide for 75$/mo from Walgreens with Rx go coupon. Inhalers? Canadian pharmacy world.com or cost plus pharmacy.
Of course it works better if we didn't have a profit based medical system, but until this country is ready to grow up a lot, we've got to save as many as we can with what we've got.
18
u/flamants
Wouldn't paying your deductible month-by-month actually be better for most people than having to pay it in one lump sum anyway? It's like a built-in payment plan. I hope you at least tried to explain it to him.
10
u/Flaxmoore
I see the same thing with therapy and the like, too. My therapy appointments are $200 every two weeks until I meet deductible, then they’re $23.
8
u/1234ld
Admittedly, I’m that person filling EpiPen Jrs x 1 for each kid for each location we need one on December 29th because 10% coinsurance even though we meet our $4500 deductible in February thanks to my husbands MEfRVO injections q6 weeks
8
u/Koumadin
Brenzaavy is $46-49 per month SELF PAY at costplus depending on whether the patients get 30 or 90 days
7
u/Hanzilol
As a midlevel, we have our shortcomings, but at least we're not completely out of touch with poor people, so we have that going for us. But you're close to getting it. The system is illogical. It exists like that because it makes it proportionally more difficult for lower income people to get ahead. Healthcare isn't just a profitable industry in the US, it's a crucial part of the broad economic system intended to keep the class divide intact.
7
u/Miami_Mice2087
sometimes the prescription deductible is separate from the surgical deductible. Pt needs to talk to his insurer.
You could find out if the drug is affordable through needymeds.org or goodrx.com or a big box/pharmacy chain/warehouse store's cheaper drug list. Or if there's a generic med they can take instead of the expensive brand-name. The pharmacist may be more knowledgeable about that.
There's also mail order from Canada or Mexico but that's risky, your refills may not arrive in time. Write a 3 month supply so the pt has plenty of lead-time to order refills.
5
u/SpeechPrudent8409
Thanks to the ACA health insurers have an incentive to maintain high healthcare costs as they’re statutorily limited to spending 20% of revenue on non-healthcare expenses.
5
u/iReadECGs
I used to take one big 2+ week vacation at the end of the year and not much else. I had to move it because patients all wanted their cardiac procedures right at the end of the year because of their deductibles. If we missed 12/31, then would sometimes just disappear (or worse) until the next year causing delays in important care.
3
u/herman_gill
I am so glad, and also so sad for my former patients in the US that I am no longer practicing in the US. In Ontario (Canada) for Trillium drug coverage patient's out of pocket expenses are capped as 1% of their income every 3 months for covered drugs. Any hospital based care is literally fully covered.
Although at the same time this is annoying because I can send a patient for an EGD+biopsies to check for H. Pylori and that's fully covered, but they have to pay $50-100 out of pocket for a urease breath test or H. Pylori stool antigen, unless it's done inside of a hospital.
3
u/Rdthedo
I hate bandaid medicine.
With that said, one potential variant of bandaid medicine for this scenario is to use manufacturer’s coupon (which sometimes works towards deductible as well). I had an expensive med a while back, and the coupon lowered cost to like $50/mo or something until deductible was met (difference of med before coupon still worked against deductible), and within a few months it was down to $15/mo.
3
u/HOSTfromaGhost
…an to make it even more complicated, sometimes medical and pharmacy are two different deductibles.
Their plan design is the lynchpin. Folks need to read their EOC to see what’s covered and to what extent.
Better yet, dump the EOC into an LLM and create an agent to help you understand your benefits and cost shares.
2
u/dpzdpz
That's also why US tax law is complicated.
As a bonus, it's written by those who make a lot of money.
2
u/Sjeljakt0
I mean just read the comments in this thread in the medicine subreddit. Most providers don't even understand individual plans let alone the broader economics. Part of the reason they can be so cheap in other countries is because the US overcharges. It's an inconvenient truth that many choose to ignore that without financial incentive, the rate of medical developments would slow to a crawl. Someone, somewhere has to pick up that bill.
Are there better ways to do it than we do here? Absolutely there are. Is there downright evil overpaying of CEOs and other stake holders? Also absolutely. But anyone pretending that we can just switch to socialized medicine in the US and there won't be any broader impacts is intentionally ignoring half of the picture.
2
u/DrTestificate_MD
The order of claims can only matter if there is a difference in coinsurance. If you had the luxury of ordering your claims, you would want to put claims that would have coinsurance first so that it eats up the deductible anyways. But I think this is generally a niche case any not really applicable for most people.
2
u/halp-im-lost
Honestly as I’ve gotten older I have come to realize a good portion of adults have the financial literacy of a ham sandwich. So, yeah, not surprised your patient doesn’t understand their plan doesn’t make financial sense.
2
u/bikerchickelly
I can make payments on a hospital stay. I can't make payments on my monthly meds
1
u/A_Cute_Infarction
Sending thoughts and prayers from the British NHS ❤️
1
u/FreedomInsurgent
we have a love- hate relation with insurance companies. Docs generally oppose universal healthcare because they think it would decrease salaries, but patients get shafted by this for-profit bullshit.
u/trixiecat
I tell my patients to do what I do - put money aside every month planning ahead for next Jan when insurance resets. I tell them to pick lowest out of pocket max plan they can as they will meet it. Just know you will pay 1-5k$ first few months of year and budget accordingly. This does not work for the donut hole patients sadly. Just the ones who suck at thinking ahead
Single biggest challenge for the U.S. population is getting patient to exercise more, eat better, and take medications as prescribed. You’ll prevent far more morbidity and mortality with this than any new drug or technology.
235
u/FlexorCarpiUlnaris
the combination of multiomics, AI and quantum computing
My patients need reliable access to food and a home free from physical violence.
194
u/M1CR0PL4ST1CS
if I have to read another post talking about the potential for “AI” to revolutionize medicine I might actually have a stroke
192
u/basketcase0a0
I would like research on how to get rid of AI. The next patient that tells me they asked ChatGPT about their symptoms might cause me to retire.
112
u/Nivashuvin
”multiomics, AI and quantum computing” has to be the most bullshit trifecta I’ve ever heard. It makes me physically cringe.
It also makes me question if most of this OP is written with or by AI which I just can’t take seriously.
81
u/RealAmericanJesus
Honestly the biggest problem in my life is the technology sometimes. I've been in healthcare since the days of paper charts, med carts and phones that connected to the wall. I feel like the more that technology expands the less time I get actually having patient facing time and the more time I spend looking at screens. And some facilities have these insane expectations around patient messages that assumes infinsae availability to answer questions about what their chatbot diagnosed them with where you have to answer them within a limited time frame. And I use to be able to just call their pcp up and talk med changes but now it's impossible to do that do I'm having to click through a million different epic connects cause I work in psych and my parents aren't good historican. It's a constant routine of clocking boxes opening systems and closing them and writing things in one document and parting them to another because the good EHRs are super expensive and so clinics don't invest in infrastructure so have a basic note aggregator that crashes every 5 seconds.
Like the more the technology tries to make my job easier the more I am bogged down with tasks that I'm not reimbursed for at many places and the harder it gets to coordinate care with other provides and agencies and the less face to face time I spend with my patients cause I'm basically held captive by a screen and the every growing tasks of 'innovation"
54
u/vonRecklinghausen
ID...gesture vaguely everywhere
25
u/hippoberserk
In anesthesia, intraoperative care is really good. The place that needs the most work is pre-op optimization and conditioning. We can take increasingly sick patients to the OR and get them to 30 days post-op. But whether it is pre-op anemia or nutritional status or exercise capacity, etc so much more can be done
21
u/Fragrant_Shift5318
Degenerative disc disease lumbar spine . A lot of the treatments just aren’t effective. They can help manage pain, but don’t always prevent disability chronic pain and loss of function.
12
u/chiddler
Midlevels with high quality study design I suppose.
9
u/tea-sipper42
Imo, functional disorders.
Very poorly understood by scientists, patients, and doctors alike
Highly stigmatized
Affect a huge number of people
Significant symptom burden, disability, and treatment-related harm
Patients often develop long term distrust of the medical system.
I have absolutely nothing to offer them except sometimes a few sessions of physio. We don't have any publicly funded programs or centres in NZ that manage these patients. Almost none of them qualify for mental health services. It fucking sucks.
7
u/mtbizzle
I'm NOT any sort of expert in quantum computing.
But do we really have good reason to predict that it'll significantly shape the future of healthcare?
My 100% lay understanding is:
(1) quantum computers are only useful at performing a function if you provide it an algorithm it can execute much faster than a standard computer;
(2) there are very, very few such algorithms that have been created;
(3) it's extremely difficult to find/create new algorithms; progress has been exceedingly slow;
(4) most work is being done on the computers themselves, not the algorithms
(5) ive heard arguments from experts that the type of problem where a quantum computer has a marked advantage over traditional is quite narrow and unusual, so it might be unfounded hope/wishful thinking to believe these will push progress forward in all sorts of domains
What tasks are quantum computers going to revolutionize that are relevant to medicine?
6
u/KetosisMD
The negative impact of stress on the body.
5
u/awesomeqasim
In the US…let’s at least get our patients actual access to care, healthy foods, shelter, exercise etc to get ourselves up to the standards of other developed countries first…
3
u/CommonwealthCommando
Psychiatry – Violence.
There was a push in the 1960s-1990s to look at violence and aggression as a basic science issue, but it sort of petered out. The implications were scary, the research methods involved high distress for animals, and generally there wasn't much of an appetite for basic psychiatric research. There was some good work on amygdalotomies, but therapeutic neurosurgery for behavioral problems has a loaded history, to put it mildly.
There is some basic research, but not nearly enough. We don't know enough about the decision-making process of aggression. Aggression and anger are obviously related, but anger is neither necessary or sufficient for violent behavior. What does anger to do a brain? Can we treat anger? Can we envision an anger-o-lytic?
We effectively only treat aggression in inpatient or inpatient-adjacent settings. Nursing homes, group homes, etc., and the treatment there is typically just enough sedatives to keep the patient from hurting anyone. Is there a better way?
There are no drug companies looking at any of this, so far as I know. The incentive isn't there, there's too much liability, the patient population as easily accessible, and honestly the will isn't there – SNFs and therapeutic schools are fine continuing to use sedatives instead of more direct anti-anger therapeutics.
3
u/FrontierNeuro
What about quality control, adverse effects, ethical monitoring and data gathering/analysis, etc. regarding the fascinating, deeply alarming, and increasingly popular practice of people injecting themselves with gray market “research peptides” from China without GMP manufacturing, including mainly GLP-1s like retatrutide (yes, the investigational triple agonist that essentially cured MAFLD/NAFLD and obesity while on it in clinical trials) and tirzepatide, but also a whole bunch of others? It appears to be a massive subculture already, as shown on GLP1 Forum and various subreddits.
2
u/wrathoffadra
Being protected from RVU based surgeons.
2
u/Full_FrontaI_Nerdity
Something like a continuous glucose monitor, but for women's hormone tracking, would be a godsend.
1
u/nattcakes
As great as gene therapies and multiomics are, they aren’t worth a whole lot if there are no medical geneticists. I’m not sure if this is a problem specific to Canada, but some provinces literally have 1 or even 0 geneticists.
1
u/Metsaudu
Starter comment:
What are major unmet needs currently faced in your field, that are yearning for new therapies or solutions, but to which either industry and academia has yet to look into?
Why in your opinion has it been not paid attention to - is it technological limitations, scientific unknowns or healthcare policy misalignments?