[Topspinmo]

Originally Posted by blueash

I wonder if you would care to document your "fact"? You know, real numbers. I will go first. Ohio State leads the nation in income from sports In 2023 it received about 280 million income and spent 275 million on athletics so the University pocketed about 5 million in profit to use for non athletic purposes. Don't believe me... here is the report summary


Now that is pretty meaningless unless you know the total non-sports budget of OSU. If it is 10 million then the 5 million sports profit is huge. But the real fact, the truth is that for 2024 the budget for OSU is over 9 billion dollars. The 2024 and 2025 budget is here.

So tell me again about how sports income is the economic engine for D1 schools when the biggest receiver of sports income gets almost no net income from its sports program.

OSU running a profit at all is not the usual. Here is the key quote from a PBS review of the issue
"expenditures by college athletics departments are such that, with the exception of a small number of schools, athletic expenses surpass revenues at the overwhelming majority of Division I programs"

So your fact is not holding up very well to the light of actual information. Opinions based on false beliefs are a big thing in the country right now. See my tag line.

Student loans are the economic engines for colleges at taxpayers expense.

[Topspinmo]

Originally Posted by chuckpedrey

Recently a man told me of taking his wife and two kids a Tiger preseason game in Lakeland and he dropped close to $1,000 on tickets and refreshments

And probably charged it equating to paying even more.

[jimbomaybe]

Originally Posted by Shipping up to Boston

Identifying a problem is the first step to correcting one!

And I wish you well in that journey

[golfing eagles]

Originally Posted by Shipping up to Boston

Can I ask the question of both of you... was the practice of medicine easier from 1960 to the 1980's? In terms of colleagues that you worked with having those qualifications as you mention....but the administrative side as well (ie ; overcrowding, insurance mandates and processing, staffing in general etc)

That is a very good, but also incredibly complex question that would require a very long answer. If I had to choose 3 sentinel events during the period of 1960-2000 they would be:
1) The passage of Medicare and Medicaid in 1966 along with the rise of 3rd party health insurance.
2) The explosion in the number of lawyers and the financial bonanza of medical malpractice litigation along with juries that could be manipulated into huge $$$ verdicts
3) The Libby Zion case against Lenox Hill that changed the face of medical education.

To briefly elaborate:

1) The government and insurers getting involved meant a huge bureaucracy and a system that only reimbursed for acceptably coded diagnoses. This led to an explosion in diagnostic technology, sub-specialists and cost, just so the "correct" 7 digit code could be used in billing. Our practice had 5 FTEs just dealing with these programs and insurers. As a result, a routine office visit in 1965 was $3, when I retired in 2015 it was $135---much higher than inflation in general.

2) The runaway jury verdicts and litigation for "mal-occurrence" rather than true "malpractice" has led to the defensive practice of medicine---ordering every test in the book to protect oneself from lawsuits. The last estimate I saw 10 years ago was $600 million/year in unnecessary testing.

3) The Libby Zion case alleged that this young woman who provided zero information to the residents upon her presentation with abdominal pain was "killed" because the resident was "tired". In fact, when he ordered Demerol for her pain there was no way to know she was on the MAO (mono amine oxidase inhibitor) Nardil, a powerful antidepressant, and they could create a fatal interaction. In the malpractice case the jury found in favor of Lenox Hill and the resident. However, her father was an editor of the NY Times and a friend of the governor Cuomo, and was able to push through legislation limiting the hours a resident could work.

In my opinion, this ultimately led to a change from taking care of the patient's problems to a "shift mentality" where doctors were watching the clock. Because of the tradition shift time, this led to the disgusting black humor motto of "keep them alive till 7:05", because then it was someone else's problem. We found this beginning about 2000 when we were hiring new physicians to our practice. It as amazing to the rest of us, 20 year veterans often stayed to work on practice issues, phone calls, and notes to 7 PM that the new guy was on his way home every day at 4:55.

And to answer the last part of the question----yes, in the early days we had physicians of equally good quality and were all on the same page as far as philosophy of patient care. We believed that our focus was on quality patient care and financial rewards would follow. The next generation, although we offered a great practice opportunity, was focused on reimbursement and time management. The worst were the orthopedists. If you went to one with shoulder and hip pain, they would tell you to pick one and make another appointment to evaluate the other. Then you would get billed 99205 for the first and 99214 for the second. (I realize those codes mean nothing to most of you, but they are pretty much stretching the line of overbilling)

That's long enough for now. I hope the other physicians respond as well.

[Shipping up to Boston]

Originally Posted by golfing eagles

That is a very good, but also incredibly complex question that would require a very long answer. If I had to choose 3 sentinel events during the period of 1960-2000 they would be:
1) The passage of Medicare and Medicaid in 1966 along with the rise of 3rd party health insurance.
2) The explosion in the number of lawyers and the financial bonanza of medical malpractice litigation along with juries that could be manipulated into huge $$$ verdicts
3) The Libby Zion case against Lenox Hill that changed the face of medical education.

To briefly elaborate:

1) The government and insurers getting involved meant a huge bureaucracy and a system that only reimbursed for acceptably coded diagnoses. This led to an explosion in diagnostic technology, sub-specialists and cost, just so the "correct" 7 digit code could be used in billing. Our practice had 5 FTEs just dealing with these programs and insurers. As a result, a routine office visit in 1965 was $3, when I retired in 2015 it was $135---much higher than inflation in general.

2) The runaway jury verdicts and litigation for "mal-occurrence" rather than true "malpractice" has led to the defensive practice of medicine---ordering every test in the book to protect oneself from lawsuits. The last estimate I saw 10 years ago was $600 million/year in unnecessary testing.

3) The Libby Zion case alleged that this young woman who provided zero information to the residents upon her presentation with abdominal pain was "killed" because the resident was "tired". In fact, when he ordered Demerol for her pain there was no way to know she was on the MAO (mono amine oxidase inhibitor) Nardil, a powerful antidepressant, and they could create a fatal interaction. In the malpractice case the jury found in favor of Lenox Hill and the resident. However, her father was an editor of the NY Times and a friend of the governor Cuomo, and was able to push through legislation limiting the hours a resident could work.

In my opinion, this ultimately led to a change from taking care of the patient's problems to a "shift mentality" where doctors were watching the clock. Because of the tradition shift time, this led to the disgusting black humor motto of "keep them alive till 7:05", because then it was someone else's problem. We found this beginning about 2000 when we were hiring new physicians to our practice. It as amazing to the rest of us, 20 year veterans often stayed to work on practice issues, phone calls, and notes to 7 PM that the new guy was on his way home every day at 4:55.

And to answer the last part of the question----yes, in the early days we had physicians of equally good quality and were all on the same page as far as philosophy of patient care. We believed that our focus was on quality patient care and financial rewards would follow. The next generation, although we offered a great practice opportunity, was focused on reimbursement and time management. The worst were the orthopedists. If you went to one with shoulder and hip pain, they would tell you to pick one and make another appointment to evaluate the other. Then you would get billed 99205 for the first and 99214 for the second. (I realize those codes mean nothing to most of you, but they are pretty much stretching the line of overbilling)

That's long enough for now. I hope the other physicians respond as well.

It’s a great first hand, boots on the ground breakdown . I appreciate the insight!

[ThirdOfFive]

Originally Posted by golfing eagles

The really, REALLY sad part is that there is so much more complexity and material to master now than in my class of 1984, which in turn was probably much more than in 1960. We need smarter, not dumber candidates, judged by qualifications and NOT demographics.

Blasphemy!!

[justjim]

Originally Posted by golfing eagles

That is a very good, but also incredibly complex question that would require a very long answer. If I had to choose 3 sentinel events during the period of 1960-2000 they would be:
1) The passage of Medicare and Medicaid in 1966 along with the rise of 3rd party health insurance.
2) The explosion in the number of lawyers and the financial bonanza of medical malpractice litigation along with juries that could be manipulated into huge $$$ verdicts
3) The Libby Zion case against Lenox Hill that changed the face of medical education.

To briefly elaborate:

1) The government and insurers getting involved meant a huge bureaucracy and a system that only reimbursed for acceptably coded diagnoses. This led to an explosion in diagnostic technology, sub-specialists and cost, just so the "correct" 7 digit code could be used in billing. Our practice had 5 FTEs just dealing with these programs and insurers. As a result, a routine office visit in 1965 was $3, when I retired in 2015 it was $135---much higher than inflation in general.

2) The runaway jury verdicts and litigation for "mal-occurrence" rather than true "malpractice" has led to the defensive practice of medicine---ordering every test in the book to protect oneself from lawsuits. The last estimate I saw 10 years ago was $600 million/year in unnecessary testing.

3) The Libby Zion case alleged that this young woman who provided zero information to the residents upon her presentation with abdominal pain was "killed" because the resident was "tired". In fact, when he ordered Demerol for her pain there was no way to know she was on the MAO (mono amine oxidase inhibitor) Nardil, a powerful antidepressant, and they could create a fatal interaction. In the malpractice case the jury found in favor of Lenox Hill and the resident. However, her father was an editor of the NY Times and a friend of the governor Cuomo, and was able to push through legislation limiting the hours a resident could work.

In my opinion, this ultimately led to a change from taking care of the patient's problems to a "shift mentality" where doctors were watching the clock. Because of the tradition shift time, this led to the disgusting black humor motto of "keep them alive till 7:05", because then it was someone else's problem. We found this beginning about 2000 when we were hiring new physicians to our practice. It as amazing to the rest of us, 20 year veterans often stayed to work on practice issues, phone calls, and notes to 7 PM that the new guy was on his way home every day at 4:55.

And to answer the last part of the question----yes, in the early days we had physicians of equally good quality and were all on the same page as far as philosophy of patient care. We believed that our focus was on quality patient care and financial rewards would follow. The next generation, although we offered a great practice opportunity, was focused on reimbursement and time management. The worst were the orthopedists. If you went to one with shoulder and hip pain, they would tell you to pick one and make another appointment to evaluate the other. Then you would get billed 99205 for the first and 99214 for the second. (I realize those codes mean nothing to most of you, but they are pretty much stretching the line of overbilling)

That's long enough for now. I hope the other physicians respond as well.

Thank you for your informative post.