I support it. If you listened to the town hall meeting in Colorado this weekend all doctors support everything he is doing, "The doctors are on board" which is far from the TRUTH. Obama equates AMA with all doctors.
Excellent! I am 100% in support of the Physician's Appeal, and have been working to educate family and friends about the pitfalls of HR 3200 as it is currently written.
I am in!!!!! I am amazed that the AMA yesterday on Fox News had little or no comment on the insults physicians have endured from this administration over the past month. It is obvious that we are the final line of defense for medical care in the US. Put my name as large as John Hancock on the Declaration of Independence. That way, if they come after us, they will know who will be fighting them.
Yes, Obama makes it sound like physicians agree with him.
It is an ABSOLUTE INSULT and slap in the face that he is not even addressing malpractice reform in this process. If there ever was a time to do it, it is now. We all know the trial lawyers are the #2 donators to the Democrats, but the hypocrisy of tying to "reform" medicine without addressing tort reform is off the scale and it's about time someone CALLS his bull$#^$
Signed on. The American people must know that the real american physicians DO NOT support this travestry and we must reveal the AMA for what it is and that they do not represent the voice of physicians.
I did not sign and do not support any appeal that does not include the promotion of primary care as its key component. Why is it so difficult to have specialists understand the importance of primary care? Shame on you for uniting to protect salaries rather than trying to control costs and improve pt care. If all of these suggestoons are put into place, don't fool yourselves--they won't improve pt care or control costs to stabilize a broken system. The only thing that will do this is bolstering primary care and getting rid of a perverse fee-for-service system that innordinately promotes procedures and surgeries and expensive tests, rather than promoting health.
Sermo Doc 25: #4 is one way to address the issue of paying primary care more fairly; numbers 2 & 3 address improving care; #1 is a way to control costs. Are you for real? This is a great start. SIGN ME UP!!!!!!!!!!!!!!!
Wonder if #1 should be further down the list as many view the most important points at the top of the list .... is that more important than the rest .... if could only have one, which would it be .... if two, which and if three which.
The above mentioned measures help US ALL. The "specialist vs primary care" crap that managed care and capitation brings has GOT to go. Count me in as well!
Those charlatains in the AMA are not representative of any physician that I am associated with. They are an embarrasment to the medical profession and should not receive one solitary penny from any of us. When they were rebuked by the president regarding tort reform they booed meekly! They are stuffed shirts that are not representing any one but their own political gain. In short they are P.A. L's. We need a new association that is in tune with the WORKING/ Practicing docs of this nation.
Chris Wallace asked our esteemed AMA President, Dr. Rohack, if there were less interventional options to reform healthcare from the physician perspective and he continued to support HR 3200 with the same lame excuse that the problems can be fixed in conference committee. Why has the AMA sold us out???
AMA should be asked to show its real strenght , they automatically sign up the interns/residents to there membership , which is not right , my wife is a PGY2 Internal Medicine --she NEVER sign up for AMA membership.
Secondly all of SERMO community members who are recieving JAMA with out active AMA membership , should stop recieving this publication-- in PROTEST to AMA policies , i am sure they are making more money on Ads- on JAMA , by showing there readers list , which include us
reform must include not only minimal governmental intrusion but insurance yahoos as well. Nothing pisses me more than some desk jockey pencil pushing bozo, who may be a geek physician who would not recognize a patient banging on his door and who barely sees patients the half day per week scheduled and canceled, from telling me 'you can't do that' and once the clinical situation is presented, 'you can't do that'. They have no legal liability and should be involved in clinical decisions. and that is the profit motive. All too often the decisions allow them a bigger office, desk, chair, holiday. Profit motive, therefore involvement, therefore public option or non-profit cooperatives with initial government backing. If Dick Armey is right, and there are 1300 insurance companies, then I'd like to know how many, and which, corporations run those 1300 companies. I suspect the number can be whittled down considerably. Allow a physician to hang a shingle and not be shackled by alphabet city of hmo, ipa, etc, then I can sign.
Sermo Doc 25 - PCPs in all other countries with socialized medicine make even less than American PCPs. In the eastern european block they drive cabs for spending $. In Britain they have side private offices. In Canada they go to Florida for two months a year when the $ stops. By allowing the insurance companies, hospitals and government to make this a zero sum game (one physician's gain is another physician's loss) we all lose. 80% of the $ go to them. If PCPs got 1-2% more there would be plenty for you. The way we are headed is a PCP supervising a gaggle of NPs or NPs practicing independently. MD PCPs will be extinct.
Just a suggestion - change the last line to ". . . honoring the oath of our profession." Most of us probably did not take the Hippocratic Oath (which prohibits surgery), but rather took one of the other physician oaths, such as the "Physician's Oath" adpoted by the World Medical Association.
I agree with the items here, but they miss the point.
We are not having a national discussion about health care insurance reforms to make physicians happier by reducing insurance hassles and increasing reimbursement. We are trying to address the problem of the uninsured and the excessive cost of insurance which is bankrupting our economy (except for the health care sector, of course).
Unless Sermo can address the key issues in health insurance reform, it will remain a small player in the big picture.
Here here!!! Signed and happy to see something like this.
Sermo Doc 25...reality is that your already crappy reimbursement will continue to decrease under Obamacare. "United" usually means that no one gets special treatment and no specialty should be promoted as being better than another; or is primary care the next special interest???
mgadoc....seems we are just following the administration's lead. Somewhere along the line (when convenient for agument's sake) "healthcare reform" got turned in to "insurance reform".
"In every crisis there is an opportunity". When patients get tired of waiting in line in the ER, those of us left in primary care can hang our shingle out and accept CASH for our services. Unless, of course, our license to practice medicine is tied to participating in Obamacare. We need to scream loudly that whatever system is put in place should also be the system that is used by our reps/senators and all federal employees.
I am also disgusted that our president would demagogue doctors as the enemy
(e.g. ripping out tonsils and cutting off legs just to make a buck).
It seems to me that the American people are finally waking up to what this adminstration wants to do which is to take over every aspect of our lives. The
threat to our health care sytem is the last straw. "I'm mad as hell and I'm not going to take it anymore"...and for speaking up, we are called an angry mob.
God help us...
PS: I have signed my name to the appeal. If the Chicago gang in the White House are upset with me, then perhaps they will force me to retire earlier than planned.
Uh, Dr. Palestrant and others, show me one shred of data that tort or malpractice reform has changed physician behavior or overall costs of testing in any state that has enacted it.
Health.Care.R. will not return optimal results while compensation for services continue to be dependent on volume of pts. and number of test ordered (as it is presently). Truly a dager in the heart of legitimate excellence of care but a super-charged magnet in the pockets of the unscrupilous mercaders of the explotation of disease and infirmity
G,G.G
I think some of you are missing the point: spending more time with patients benefits _patients_. Medical decisions made by doctors and patients together benefits _patients_. It's not about protecting turf or salaries; it's about protecting what we do every day--the doctor-patient relationship. Whatever gets "reformed," this must be protected at all costs.
radiorahul: Seeing many more "emergencies" than the average rheumatologist, go through a few bogus malpractice assaults on your ability and then try not ordering those tests that would eliminate any question that your clinical judgment was sound. It is hard. But what you don't take into account is the medical student and resident now watching you order that unnecessary Sermo Doc 307ary test therefore learning from the master that this must be proper medicine instead of relying on training, hands on exam, proper history, and repeat exams.
I agree and I signed. I hope this gets even more press.
But what would be the alternative to CPT codes and would physicians get to be involved if this were truly considered?
Also exactly how do you reform insurance companies without starting over and exactly how do you correctly enforce this reform?
If I had one choice I would pick, Let doctors do their job in the manner in which they are trained to do without everyone else telling them what to do, when to do it, and whether you can do it or not.
just as an aside...in my practice , my alternative to CPT codes has been more along the lines of how attorneys charge, which is more along the lines of how cabbies charge, which is to set the meter running...
Sermo Doc 57, Anesthesiology
We must stand firm. Remember It was after medicare was proclaimed in the 70's that the cost of hospitalization started rising and with every JCAHO inspection the cost rises astronomically further. Get the government out of the practice of medicine
If we are really interested in Tort Reform then let's work on outlawing PUNITIVE damages by individuals. Punishment is one thing that belongs to the State and not Vigilantes.
Amazed that hardly anyone in power mentions tort reform, but that's no surprise given the make-up of Congress.
Amazed as well that it took ordinary citizens to put the brakes on this, when those who are supposed to protect our interests (AMA and our senators and representatives) seemingly could not.
I agree with Sermo Doc 45, the appeal sounds wonderful but what are the possible solutions? We are all asking for a change but we should be prepared to put something out there as an alternative, otherwise our appeals only go so far.
I believe that we should seriously consider billing by time (at least for face-to-face patient encounters / E&M services). Then there is no "fraud" in terms of up-coding or using the wrong E&M code or CPT code.
I was also disappointed with the AMA president's comments on Fox News Sunday yesterday. When did the AMA become so liberal? I had always considered the leadership more moderate in the past.
I agree we need an alternative to the AMA.
I've signed my real name because I personally think that anonymous signatures will not carry any weight with politicians & lawyers (though I won't devalue the MDs who chose the course of anonymity because they may have had good personal reasons for doing so).
I've signed Sermo's declaration because the generally principles expressed therein are generally cogent & in concurrence with my own on the matter of health care reform. My signature does not necessarily indicate, however, unconditional & unqualified concurrence with all of Sermo's or the AMA's specific positions on health care reform.
For example, the Sermo complaint regarding the AMA's retention of its (the AMA's) revenue-earning copyright on the medical dx & tx billing code is somewhat captious in the sense that I personally (&, I think, probably other MDs) would prefer the AMA (with all of its faults) to continue, for the time being, to generate billing codes rather than to have various & sundry suspect non-Gov't entities assume this task, e.g. the trial lawyers, 'consumer' groups, labor unions, media/academia elites or corporate CEOs (whether of the health care industry or not).
To have 'the Gov't' unilaterally set billing codes would be 3/4 of a step away from a fully nationalized & socialized medical care--a favorite of many but an portentous option which should be thoroughly debated & voted upon, in toto, in broad daylite, by the full weight of the constitutionally-ordained political process.
In short, to replace the AMA with anybody else at this time as authors of the CPT (or any alternative to be widely-used med billing code) would be like replacing the Saigon regime with a Viet Cong-sponsored 'coalition government'!
Full disclosure:
1. I am a member of American Psychiatric Association (which may be within the extended membership penumbra of the AMA).
2. The AMA will never represent MDs with the virility needed because the AMA has neither the Mouth of the Trial Lawyers nor the Muscle of the Teamsters!
I am pleased that tort reform is the number one item on the agenda. For me personally, I consider tort reform to be the litmus test for ANY reform plan that is put forth. I don't care how doctor-friendly and patient-friendly any of these plans might become - if they don't include tort reform I WILL NOT support them!
All MD's need to write a letter to the editor of your newspaper and your US congressman and US Senators about the need for tort reform,more regulation of the insurance companies and their obscene profits and dishonest tactics in dealing with physicians, and fixing Medicare reimbursement to MD's.
I'm in, and I'm glad to see such a robust cross-section of specialties represented. As an FP, at times I have felt all alone in my opposition to this "reform" because the AAFP and national "leaders" in Family Practice seem to be in the tank for it. Thanks for giving me voice.
Read Dr. Janda's article, as posted on Snopes. It is a real eye-opener, and it begs us (indirectly) to speak to and to act on the problem before we, and the American people in general will be swallowed up in an utterly untenable situation!
Agree. For the doubters (few) re: benefits of tort reform... look at Texas.. after Meaningful reform, doctors from All over the country are flocking there.. they cannot give them licenses fast enough.. may not decrease cost of medicine a lot... but certainly will increase pt choice!! Good luck in the battle for justice!
I showed up in my white coat and scrubs at the Grand Junction, CO town hall meeting. I warned folks that the Patient's Bill of Rights does not include the right to be seen by a medical doctor. Under a reformed government run health care system, t he he Fed could decide to save money by having PA's and NP's interfacing with patients, and using physicians more-or-less in the background (to sign off on their medical records once a month). Is this what is meant by the rhetoric: "You'll get to keep your own doctor?" Meaning, his or her signature will appear on your chart, but don't expect the right to be seen (physically) by him or her?
I will sign on. Some comment needs to address the police state mentality of the current and past Medicare administration and laws passed by Congress especially the RACs (Recovery Audit Contractors) who can and will find issues with ANYONE's CPT documentation. It is simply extortion by any name. The complicated CPT system promotes it. It will cost physicians more money to legally prove they did no wrong than to simply fold and pay back their hard earned money to the feds.
I will be proud to sign with my real name. See more patients in less time, pay more in malpractice, get reimbursed less and less - no wonder physicians, especially OBs like me, are leaving clinical practice in droves. Patients in rural areas often have to drive hours for prenatal care or to reach a delivering hospital. We are all in the front lines of the healthcare crisis in all its forms, and it's time we stand up for ourselves and our patients.
Love that No.1 is that tort reform will help reduce cost. I truly believe that to be the case.
Sermo Doc 89 is right on that RACs can and will find you at fault no matter how hard you attempt to be accurate in your coding. As I understand it they are paid on a commission per infraction. Talk about a conflict of interest. This does nothing but make physicians less and less likely to see M'care patients.
Interference by insurance companies must stop - most definitely!!! It's a slap in my face after years of medical training and 23 years of experience to have some clerk not even born when I graduated tell me that what I am ordering is not in the patient's best interest.
Agree that if something is not done to correct the inequity that time spent in cognitive treatment is not as valuable as procedural treatment then we will lose the cornerstone of healthcare - the Primary Care Physician.
Politicians listen only when they have to.Keep up the good work the system needs improvement but putting the patients needs first and physician input to guide change is the only smart way.Politicians do not understand Medical Practice. I begin to see the same pattern as happened in Canada-attacking providers with grossly inflated claims of how much we are paid,blaming us rather than beaurocracy for increasing costs.It is great to see a focused group representing our point of view -divided we fall.
Sermo has raised a storm. We should not let go of the momentum. To me Insurance reform should be the most important part of change apart from malpractice reform. Remove pre- existing condition, stop increasing co-pays and deductibles at will and reduce premiums so more can afford insurance, pay clean bills fast, stop putting the burden of "Co-ordination of benefit" on the physician. Now a days we have a lot of generic drugs for $4 a month and most Insurance company pushes for these only so they don't have to pay anything. I agree with the charges by time like the plumbers and technicians instead of CPT. Also most primary care docs like me already give a lot of free and reduced fee care and the public should know about this so their perception changes.
I'm having a hard time with this thing. Here's why:
1. Unnecessary tests and procedures are reduced through tort and malpractice reform
I agree w/ the statement, but there's nothing in any congressional proposal to address it, and I don't think nationwide malpractice reform is doable in the time we have. Conversely, tackling this issue can turn it into a huge red herring to distract physicians from the rest of the bill.
2. Doctors are allowed to spend more time with their patients and less time on paperwork by streamlining billing and making pricing more transparent (create an alternative to CPT codes)
If CPT is tossed out, it is a virtual certainty that ongress will turn to the insurance industry to write its replacement. I"m unhappy with the AMA, but I would like to consider other options before asking congress to emasculate the one physician's group which currently has credibility (i.e. large sums of money) with Congress and recognition by the public.
3. Medical decisions are made by physicians and their patients, not insurance company administrators
This already exists - the insurers claim that they don't make medical decisions - only payment decisions. Technically, they're right. It's the patient's problem if the insurers won't pay, but that doesn't mean the insurer has forbidden them to have the procedure. In practicality there's no difference, but in law there's an enormous difference.
4. Adequate supply of qualified physicians is assured by revising the methods used to calculate reimbursements.
This statement assumes the continuation of the current insurance payment paradigm, which is the central problem in the whole situation. The chief evil of insurance is that it separates the pt from the physician economically. A better solution which could, if addressed properly, obviate the need for statement #3, would be to ask Congress to eliminate employer provided insurance. Mandate insurance purchase by individuals (with vouchers for the poor, and possibly tax breaks based on amounts spent) and also mandate that insurers accept all applicants while limiting the range of charges insurers can apply for the sick vs. the healthy. This meets the universal coverage desire of the democrats, appeals to the Republican's desire for personal responsibility for health care, guarantees the insurers a huge increase in the applicant pool, and protects the ill from unfair treatment by the insurers.
I think I would rather we do nothing than do something which could be counterproductive. The AMA and the professional societies are the only organizations really able to negotiate the SGR - can anyone here claim expertise in all the complexities of the damn thing? Do we really want to cripple the AMA economically in the immediate future? I don't like 'em, but I think they're the best we currently have re: the SGR. If we waste efforts on things like statement #4, then we indirectly indicate our support for the current system in its present form - we're simply another special interest group looking for tweaks around the edges. The basic format is broken, and that's where the change needs to occur.
Signing my real name after I finish with this post..
There perhaps should be a 5th point, in my opinion, about doing something to curtail the outrageous costs that hospital corporate entities subject people to, like when they charge someone thousands of dollars for a CT scan. It's just a stupid game they play to extort money out of insurance companies.. then the ins. co fights back and the patient gets caught in the middle, forcing them to waste their time and effort getting their bills trimmed.. sad..
The AMA is a joke..
This president is a joke along with his entire gang of socialist lap dogs.. I've had it with all of them..
While I'm on board with working for health care reform; the unending political manipulation has convinced me that the "broken system" of legislation in this country is incapable of making the pragmatic changes that we and our patients need to fix our "broken system" of health care. I strongly feel that we should be pushing at every potential avenue that moves us towards collective bargaining and organized labor style influence.
I'm tired of insurance companies and administrators removing my patient care dollars, my income, and my authority while expecting me to continue to play the three stooges game of "Look at the Birdie." Distraction and disinformation with the basic divide and conquer philosophy has worked so far but I feel Physicians are intelliegent enough to see what has happened and we have a moral and ethical obligation to both our profession and our patients to regain control over our profession and the money and power associated with it. Our previous generations of physcians understood this and we need to unite and return medicine to it's proper position.
A voice of sanity. No wonder nobody listens! Hopefully we will stick together and at least let the phony politicians know in advance that they may not be able to get away with this.
If obama does not have guts to stand up against TRlAL lawyers why he is bothered to do health reform. How can AMA stand with this guy if there is no TORT reform. Shame on AMA. They should change there name to AAP(American association of Prostitutes for selling thier soul and body to Obama for benefits).
Sermo Doc 20: "Lawyers use time. Sometimes set fee for a service. They somehow manage without CPT codes"
Some entity whether it be govt or insurance companies will attempt to take over this task. Agree with Whatagas on this point. Would love to have the ability set fee for a service now but I dont think that will be realistic right away. So we need to be armed with additional alternatives rather than just saying let's drop CPT codes or let's just set a fee for service. But maybe proposing this now is the way to go and in that case we should be ready to explain why set fees for time or service benefit the entire system and also get patients to understand why this would help everyone.
If Dan Palestrant won't stand behind the Million Med March on October 1st, perhaps this is an alternative document that can be presented to Congress after the march on the mall. Non-affiliated community practicing physicians could let their voice be heard.
Regarding #2, I'm afraid that Dan Piss-ant is so mad at AMA that it is clouding his vision concerning coding and reimbursement. I doubt that anyone will come up with a completely new system for billing (as opposed to CPT) that won't screw just as many doctors as it helps. We'll be lucky if they don't lump all physician fees into hospital reimbursement and I think asking for a change to CPT makes that more likely.
I agree with the appeal and will gladly sign, but I think it is only a start. The other piece of healthcare reform that is needed is to change the people's expectation that enough medicine can fix anything.
I would also suggest that the oath mentioned in the last paragraph be more generalized to support the promises we made to our patients in whatever oath we may have taken--I took the oath of Maimonides, not Hippocrates.
You seem to have no trouble making use of his free service to you. If you really mean it, you should "resign" from Sermo as a sign of protest ..... actions speak louder than words. Will wait to see what you do.
I see a number of comments about insurance companies denying care, but the thing the I see more is that the initial denial and then the being on hold or phone tag until you get to the doctor who finally says sure but you've wasted 30 minutes. To me it is clear that there is some rule that says just keep denying until its clear they won't give up.
Obama said that PCPs are getting a "pittance" for preventive diabetic care and the Sermo Doc 102 gets 30, 40 or 50k for doing the amputation.
Can somebody please let Obama and the public know that if preventive diabetic care is so important, why are the PCPs getting a "pittance" why bank CEOs are getting millions?? Anybody talking about a pay raise??
Also, Sermo Doc 102s do not get 50K for an amputation, we get $700 to $1100, then we need to substract 30-50% of overhead, then taxes.
Sermo Doc 32, the answer to your question appears to be the same answer for most of the "evil" in Government in general today....the love of money and the love of power.
Somehow the wrong people were able to take over the runnings of the AMA and have not just sold us out (for money) but are helping to try to sell out the working public as well. Until Sermo I too was ignorant to the amount of money they take from us yearly. If they did not justify their existence their cash cow would die. Sad to learn how much propaganda I accepted without questioning the validity.
Maybe a call for their resignation by a large group of Docs, if it were to hit the news might motivate more people to wake up and learn how they are being lied to. It will never air on Obama Broadcasting Company though.
tort reform must not punish victims of malpractice by limiting fair compensation for injury. tort reform should severely limit attorney compensation and friviolus lawsuits! W Gordon Irwin D.O.
Unless and until patients really care about what health care cactually osts, there will never be any meaningful decrease in costs. The problems are not only related to defensive medicaine and other reasons for excessive testing, but also the entitlement mentality of many patients. When patients paid for a percentage of what they consumed from the health care system, they helped hold costs down. Now that they can "shop" and "buy" all they want for a $20 dollar co-pay, they consume as much as they can. Therefore, the cost of access, i.e. insurance premiums keeps sky rocketing. We need to return to a system where veryone involved is responsible.
Discovered reference to Sermo in AAPS News, August 2009.
Encouraged to find like minded physicians who give a real damn about the care of patients and our profession.
The Obama attempted hijacking of the health care system will be ruinous to the well being of our patients and destroy the American way of life as we know it if he succeeds.
He has utterly no clue as to the practice of medicine. His recent comments about tonsils and reimbursement were ignorant and disgusting. Totally out of his league and he has the gonads to try and take over our livelihood and lives. Disgraceful and appalling.
Add to it the fact the SOB's in Congress won't even sign up for the trash insurance plans they're foisting on the public and I want to vomit. Hit me with some more Zofran.
I signed my name because I agree with and believe in the 4 concepts presented above. I am happy to support healthcare reform if it includes the issues presented here as well as the issue of uninsured (which I have personally experienced) and underinsured Americans.
The problem is that beyond this forum most of us don't REALLY know what's in the bill and what we are appealing exactly. And that goes for the majority of Americans, including physicians, and probably even the congressmen that are for or against it. I think that's been my biggest problem with Obama's plan is that no one seems to clearly explain what is in the 1100-page document.
I love to be more informed, but who has time to read it?
It is time that we have a "Union" Guild for Medical Doctors! We need to have our voices heard and NOT by the AMA. Other countries have professional guilds and they work. If we do not unite in a political group we, as well as our patients will suffer. Now is the time to unite and let our voices be heard.
tort ansd malpractice reform is NOT in all the townhalls and protests.No politician(most of them lawyers) are NOT interested. Reform STARTS with reform of our problem; So I AM IN. SEE IF AMA ORGANISES ANY TOWNHALL MEETING
See if this site works. thomas.loc.gov Can at least read some areas of interest in the bill from this website. Click on "text of legislation" and can choose what you want to read. I agree - not sure who has time to read it all.
Agree with Sermo Doc 116. Obama knows little about healthcare and demonstrates this daily. He also recently compared humans to cars when talking about penalizing hospitals and docs for readmissions within 30 days. He said, "They must not have done the job right. If you had to bring your car back within a month for the same problem, would'nt you be upset?" Demonstrates that he has such a superficial understanding of what is really going on. Which is why physicians should be running all of healthcare.
Although I signed and agree with the letter, the reality is that the culture of the American people is such that real change in health care delivery expectations will not occur without cultural change, and cultural change is generational...... Americans want the best without holding back any options or testing, want it now and want someone else to pay for it - AND compensation if it's not "perfect"...... without a change in those expectations, the system will bankrupt itself and the country - regardless of our well meant intentions.
these are good but must go further to frree medical care from practices that reflect economic incentives and to prctices that relfect rational medical care based on scientific and logical goals.
elr
I think this is a great start! Establishing tort reform is only the first step. Competent and caring doctors don't deserve to have their names dragged through the mud with a lawsuit. I don't care what the limit on the suit is. We need to increase the number of physicians going into primary care by increasing their payment. The solution is not to have a bunch of undertrained nurse practioners caring for america!
The AMA is losing membership like rats off a drowning ship. It appears that most Docs that have abandoned the AMA are giving their loyalty to their specialty society instead. I would really like to see a Federal law that would encompass "loser pays" in malpractice lawsuits. It would stop a lot of these frivolous filings just to try to settle with the insurance co.
CPT codes do not represent the true value of the work, they are a useless system that only serves to deny care.
Doctors should submit a bill based on the time they spent with the patient plane and simple. If they performed a procdure during the visit then they should bill for the time for that. Payment should be based on a system of numbers based on time increments of 10 minutes. i.e. #1=10 minutes up to a set number say 12= 120 minutes spent with the patient. We should not have to write dx codes for everything. Testing can continue to have it current set of codes without the requirement that the proper diagnose code go along with the test.
There should not be modifiers and irrelevant diagnostic codes.
I signed my real name. I don't think we should abandon CPTs until we have something better, something that we physicians develop.
As a "dread" specialist, I would like to address the primary care docs and tell you WE ARE NOT YOUR ENEMY. The IMs, Peds, Gyns, and FPs save my a** on a regular basis. I just want to practice urology, help my patients, and pay my bills, maybe have a little left over for me.
Tort reform in Texas, Prop 12, has lowered my malpractice premiums significantly. Malpractice attorneys simply don't see profit (winning the legal lottery) in many questionable cases so they don't accept those cases. If patients really have a legitimate concern or complaint, they can go to the Texas State Medical Board. Haven't ever had this happen to me, but from what I understand IT IS HELL.
If I order so-called "unnecessary tests," (usually determined after the fact) it is because I don't want to miss something that could harm my patient, not so much because I am afraid he will sue me.
We CANNOT let insurance companies, Congress, and the President divide and conquer us. ALL physicians need to stand together as advocates for our patients and for our profession. What we do IS noble and a big Sermo Doc 55 on many levels. Just ask our spouses and our kids.
Thank you Dan for providing us a forum to share ideas and to b***h about all of these issues. Keep fighting the fight! Solidarity among physicians!
I would support reform if the public would get THE SAME medical plan that congress and senate get. Tort reform is a must.
That would be the only way I would support any of this.
Cognitive doctors should be paid by the minute, just like lawyers.
Procedures should be paid by CPT code, as always.
I signed the letter because of the simplicity of the message. The more words thrown into these letters the more unlikely anyone will ever read them. I have read and looked at the 1200 page bill. The bill is complex and is incomprehensible to most Americans. The bill does not address the practice of defensive medicine. In Tennessee we have already had our experience with healthcare that covered 90% of the population not covered by private care. TNCare was a disaster, public roles were cut to prevent the State from going broke. Wellcome to the world of free care.
The legal cost in Medicine is around $30 billion/year. There is plenty of room for savings if we trim this number, but instead, the health care reform wanted to cut $500 million from Medicare (probably by paying docs and hospitals less).
No mention of tort reform since the bill was written by trial lawyers, just like Mike Huckabee said Sunday.
Why doesn't Washingon sign up for the same crap they are trying to force on the people...here's a link to petition them to accept the crap they are creating. Congressman John Fleming's site:
"Reform" is the wrong term and casts the debate in an inappropriate context. Healthcare is a commodity. Americans like to use a lot of healthcare. Because the market is not a free market, incentives and disincentives for appropriate use of healthcare are distorted. Because the market has no transparency, consumers are unable to get information on quality and cost, which are readily available in almost every other industry. Would you buy a car if you didn't know the price, the risk of mechanical complications, or how long it would last? Doubtful.
Most problems in the healthcare market derives from governmental interference,
including special legislation ( because of lobbying of course) protecting hospitals and insurance companies from competition and transparency, legislation which allows insurance companies to cherry pick their subscribers, and government driven distortions in price for medical goods and services, which the insurance companies and pharma take advantage of.
I am glad to see Sermo making an effort to engage docs in trying to shape their own destinies. The passivity of physicians in the face of dwindling control of their own professional lives has been shameful. We need to stop listening to policy wonks who don't know anything about the day to day practice of clinical medicine and start telling people 2 things 1) Leave us alone to do our jobs properly, and 2) We know more than you will ever know about the reality of delivering healthcare.
Agree with educating public about the legal cost of medicine and tort reform.
The govt's perceived need for reform is almost always supported by arguments that the US ranks low in healthcare and that there is a large number of uninsured (which somehow went from 40 million to 50 million over the summer). This along with the expense of healthcare seems central to the current administration's reasons for writing up a bill - at least that is what we and the general public are supposed to think apparently.
So we should also get the facts out there about life expectancy in the US and how these numbers vary from country to country depending on what types of deaths are included in these numbers (accidents, military deaths, ...). We know the uninsured population is partly made up of illegals, those who can afford it but dont buy it, those who think they are too young and healthy to need it, those who qualify for medicaid but dont apply, etc... The number of people who really NEED help is much less than 50 million. Enough of the lies.
This is what the AMA should have done. It makes no sense for insurance people and lawyers to make more from healthcare dollars than physicians and nurses do.
Several people have made good comments here. I agree with the general sentiment, and signed the petition. But I also agree that the issues are more nuanced than this simple document can capture. I appreciate that this peition addresses the things in our system that penalize doctors for giving good, (but not excessive) care. I appreciate the idea that there is too much documentation and paperwork, and we need a fix for that- although specifically dumping the CPT codes without a plausible alternative is rash in my opinion. But I think we all need to do some "360" thinking. To make things work better, we need to get everyone on board. We need insurance and government to recognize that sometimes talking to a patient is worth more than checking their urine. We need patients to be more closely connected to real costs of healthcare, and more responsible for using it prudently. We need doctors to stand up, like the people here, and express their desire to change things in a way that helps those who need help, but without insisting that there be no pain for us in the process. ( Realizing that practicing medicine has already gotten more painful for most of us.) And the current tort situation is without a doubt a problem in multiple ways: lets provide the protection that patients need without attorneys and malpractice insurers getting rich off the process. I really hope we can be heard, by being fair and honest with ourselves and others about what the problems are, and how we hope to fix them.
Great work and thank you. Things began to fall apart with the invention of the managed care scam. Physicians were caught off guard and we had no voice. We went from working for ourselves and for our patients to being employed by the insurers.
We went from having a career to just having a job- I want my career back. We Sermo Doc 55 too much for too long to be treated like this.
WE NEED LAWYERS IN THE SOCIETY TOO, BUT IT IS THESE FRIVOLOUS LAWSUITS THAT SPOIL THE WHOLE THING>>>> LIKE SUING MCDONALD FOR BEING FAT>>> kind of lawsuits. THERE SHOULD BE CAPS ON PUNITIVE DAMAGES>>>
I agree that unnecessary tests and procedures need to be reduced, but we need to do that ourselves regardless of what happens with tort reform. We also need a truly universal medical record document that can be accessed by every health care provider and appropriate security measures to assure that the records are only accessed and used by those involved in the patient's care.
An online straw poll on the doctors-only Web site Sermo.com found that 94% of 10,500 physicians polled oppose the bill. While the sample isn't scientific, and may have attracted an anti-AMA crowd, it's gotten attention as a vote of confidence against the group. The head of Sermo, Daniel Palestrant, has been on an anti-AMA rampage all summer, appearing on cable news stations to say that doctors have been sold out. Doctors aren't the reason why costs have risen or people can't find insurance, he argues: "Overall health care spending has gone up while physician salaries have gone down."
Palestrant accuses the AMA of being more concerned with keeping its seat at the White House table so it can protect its various ancillary moneymakers, like its estimated $75 million business licensing procedure codes to HMOs. (The AMA says Palestrant is upset because it ended a partnership deal with Sermo in May. Palestrant says he let the deal expire because the AMA doesn't care about its members.)
Whatever may motivate Palestrant, the anti-AMA bandwagon has picked up speed. Seven state medical associations--including those in New Jersey, Texas and Georgia--took the highly unusual step of breaking with their parent to denounce the bill. Others big ones like Arkansas' have also expressed deep skepticism, without specifically breaking with the AMA.
Several groups of specialty doctors--neuroSermo Doc 102s, plastic Sermo Doc 102s and general Sermo Doc 102s--have joined the anti-ObamaCare coalition and have even been joined by two physicians who recently served as presidents of the AMA.
"The AMA," says Gregory Tarasidis, a head and neck Sermo Doc 102 in Greenwood, S.C. who is currently president of his state medical association, "came out too early and too strong."
I believe we need to be cautious, as we are now finding ourselves anxiously wanting to be involved with changing the health care system....but haven't really defined for ourselves, or others, what it is we jointly feel needs changed. If we step into the arena, we should, at the very least, have decided together what it is that we are fighting for or desirous of changing. This blog alone should remind us all how very different and unique we all are. Without a consensus of purpose we could be dooped by those who indeed, have a very clear agenda (even though they may not make it clear to us).
Given a one-on-one with Obama, I'm sure any Physician who posts on Sermo could kick his ass in a debate on this reform idiocy. He's a lawyer-he lost his soul in law school.
It is sad that the AMA does not get it! Tort reform needs to be addressed!! Reimbursement for a diagnostic heart catheterization $300-400. Hospital reimbursement $8000 Malpractice $20-30K Something does not add up
Like the momentum to date-but CPT codes is not the end all--there has to be an arbitrary means to quantify work, whether in office consult, or procedure, or in hospital follow-up. I'm not saying its great, or even good, but it exists, and most are used to dealing with it. May be better to focus efforts on the other areas as eloquently stated above.
A friend wrote her Cong. (Clyburn) and was audited by the IRS the following month. I thought of signing this anonymously at first. The black helicopters fly over my house looking for some excuse to take my land, my email is read by BO & Friends, and the government forcefully confiscates half of everything I earn. Frankly, there's not much left to lose. I signed my name to the letter. Thanks, Dan.
We need to have a clear message .Hire a PR firm that can relate our message to the American people. Besides the media, we have unique access to a very large audience that trusts us- our patients. Imagine playing DVDs in our waiting rooms illustrating our concerns and suggestions. An infomercial following a single patient encounter from the time it is scheduled through the visit, coding, billing, rejection, appeals and calls to get meds and tests approved.
Oh, at some point, would like us to be reimbursed in the way lawyers are-for billable hours.
For example, I spend much time on the phone, reviewed lab work and answering questions. And I spend a lot of time with patients in the office.
Maybe the first five minutes of a phone call are not charged...but at least allow us to bill something after that
Billable hours would be a fine replacement for the CPT code system: easy to calculate, familiar form (attorneys and accountants do this), and justifiable. Billing to the patient or insurer should include: time spent directly with patients, time spent on documentation, time spent filling out forms, time spent on prior-auth/pre-certs (billed to the insurance company), phone time, e-mail correspondence, after hours and weekend call, labwork review, time spent on referrals, staff time spent on all the above, and pass-through costs for malpractice insurance.
It makes you realize how underpaid, overworked and underappreciated you are.
The best way to bring about the needed changes is to expand the current Medicare system, or something similar, to cover everyone. Those who can should pay for the coverage and those without means should receive support for the insurance. But, the payments should not line the pockets of a CEO or shareholder with a vested interest in denying coverage. PLEASE- we do not need to continue the current for-profit insurance system which takes money out of health care and puts it into private pockets. Let's expand the most popular federal program ever!
I wholeheartedly will sign. I agree tort reform is necessary for true healthcare reform. Also, primary care physicians are going to need reimbursed more (not less) in the future, or else the whole payment structure for everyone falls apart, as less physicians will continue to choose primary care out of residency, leading to more physician extenders who will be more likely to order expensive tests and refer out more patients to specialists. It may also lead to more patients self-referring to specialists, which will drive up costs as well, as patients may not be as apt to trust a physician extender. Also, health insurance companies need to stop hassling physicians or having the patients hassle us (which is what they do) regarding tests and prescriptions. They need to take much less of a profit margin or they will end up taking much less of a profit margin in the future as patients opt out of purchasing insurance and less physicians practice medicine in the future.
Eliminating interstate restrictions on insurance plan coverage would also help drive insurance costs down for millions of the "uninsured" by choice. I will sign on.
The tort reform has worked quite well in California and should be federal. As to doctors getting paid more and have the billing streamlined, it's not going to work because the basic tennets of supply and demand and market forces are the only mechanisms to control costs. Until this time-proven system is honored, medical care will continue to skyrocket and employers, premium-payers, and the government will continue to amass larger and larger expenses.
physician's appeal: short and to the point. i love the way you phrase tort reform, first, and money saver. Of course I signed, my real name. Go Team Go.
I signed it even though I have a few reservations about one aspect. Everything in the "Physician's Appeal" makes good sense and I loved it, however, what if they address (meaning they actually consider and debate - for the first time) those issues, and then decide on some kind of Co-op system which is still a government-run foot-in-the-door smaller version of the original public option? Have we not, in a way, given them carte blanche? As appealing as tort reform is (and it is vital), I can think of unnumerable plans that would do more harm than good even if they involved tort reform. That is not to say that I absolutely oppose the Co-Op idea. I just need to know more about how it is instituted and administered before I accept it. Afterall, it would not be the first time this administration has taken a representative group and exaggerated their level of complicity with the plan.
P.S. I just had another thought I need to add. Is it too late to append something to the Physician Appeal? If not, I think we need to get them to do away with the Stark Laws or whatever legal mechanism there is that prevents us from group collaboration. I mean, if we are going to enable competition for private insurance, and portability across state lines and the like, why not allow a more level playing field for those of us who will have to provide the healthcare that apparently is now considered a basic right? Everyone else gets to take advantage of power in numbers, and this administration is definitely pro-union. Why must we physicians be denied those rights?
Why there only two choices: support with signature or support without signature? Why don't we have the opportunity to vote No Support for this petition?
Tort reform is a state issue. It' s unreasonable to expect the federal government to do something in this area. I agree that some reforms would be helpful, but I think you're seeking assistance from the wrong level of government. I like your other ideas, though.
Thanks Dan, we all appreciate your hard work and you're really getting the ball rolling and building momentum, this is great. I'm adding my name to the list as well!
Your point seems to be that those physicians who oppose tort reform, oppose protecting the doctor-patient relationship, oppose medical decisions being made by physicians and patients, and oppose physicians having a voice in medical reform should have an option to vote against these things. This is a petition, not a poll. You vote "no" by not signing it.
doctors are cowards that is why insurance companies walkingig all over and laughing heartly. can we do something ,oranige and protest. it is shame that this things happening in u.s.a .
Sermo Doc 150 is right about relaying the message to the American people. Keep it basic -help them understand the issues important to us and why. Most of them will side with their physician. Encourage them to write or call their congressman.
Patients see a bill after a clinic visit, hospital stay, procedure, etc, and some of them think it comes directly from the physician. They have no idea how complicated the whole billing process is with insurance companies and how high overhead can be, let alone the meaning of tort reform and how it could improve care.
Cost shifting from medicare and medicaid costs a family of four 250 dollars a month in higher insurance fees. Fix these programs and you have solved a huge part of the problem. Having observed several lawsuits in action, I can say that the current system is completely useless. Real malpractice is not dealt with effectively. Competent physicians are harassed when they get a bad outcome, and often they sue the wrong person! Real tort reform should save that same family of four 200 a month as well. I mean does anybody really believe that people in an average family use 800 to 1400 dollars plus copays a month in health care? Or that the people who created this shell game can fix it?
I am frustrated. On these same pages Daniel you have been ranting against President Obama's health care reform. Now you are going to get what you asked for: no reform...all to the detriment of our patients. The public plan was our only leverage against the bohemeth insurance companies. Without it, we have no leverage. I am disappointed by your actions.
I signed it with my real name. Someone wanted a solution: here is my offering from my life experiences working at a subspedicalty Shriners Hospital for Children and a university Level I trauma center. This leaves the 85% who are happy with their coverage alone. Would most likely reduce their costs.
1.Bring back the system of "the county hospital" run by trainees of all kinds (med studs, residents, student RN's/RT's).
2. Implement NO legal ramifications--equal to the VA system (and these are the folks that fight for our country).
3. Faculty physicians rotate through---I would even volunteer my time for tax credit/deduction and not salary.
4. Missed appts/noncompliance with treatment results in no more access unless paying cash prior to getting further services.
5. implement best practices (no ortho procedures w/o tobacco cessation, weight loss, dietary changes etc.)
Corresponding Benefits:
1. Improve trainee experience
2. mx money saving measures such as cost of malpractice, extra test ordering, etc (ex no CT scan for RLQ pain, anorexia, WBC high)
3. Provides Teaching and mentorship
4. If pts are not motivated to take care of themselves then NO system will benefit them (pts/families have entire medical care covered by SHC and are even given money for food/outings/travel and still people are noncompliant and are "no shows". We do NO good allowing themselves to take such poor care of themselves)
5. same as benefit 4.
Would not be a two-tiered system. I have seen some pathetic trainees and pathetic private physicians. In fact, at a local "world-class" cardiac institue the fellows are much more knowledgeable than the private cards guys by leaps and bounds. All of my care and my family's care done at a training institution...I did not interfere with their training at all.
BTW-in college I ended up in the hospital with rhyabdomyolysis during spring practice for my college sport. Barely survived. Despite gross negligence by our sports MD--I did not seek legal action/compensation for never regaining ability to continue in my college athletic career.
I tried to be brief and look forward to the responses. Please forgive any spelling/grammar errors. Written during lunch break.
3. motivate folks to be compliant and care about their own health
We have a right to protect ourselves from enslavement to our government (employment at a meager salary), and to protect our patients (cost containment and rationing) at THE SAME TIME. It is ridiculous for a FP to say giving more to primary care docs IS the answer. The answers come from limited government waste (usually estimated around 50 cents on the dollar), and increased free market competition, coupled with appropriate regulation).
Sidenote: It has come to my attention recently that a large number of people in the country are actually being paid disability payments from medicare of 500- 900 dollars a month (OF OUR TAX DOLLARS), because there kid has a common illness, like asthma or ADHD. That is on top of the free medication and medical care as well. Many people in America are wanting there kids diagnosed as sick, just so THEY can get another government handout. These parents beg their community "primary care" doctors for the GOLDEN TICKET diagnosis, which pays them 500+ dollars a month until there kids hit 19 years old. To make matters worse, if the kids are older at the time of enrollment in the program, they get "compensated" for all the previous "sick" years, getting checks I have heard as high as 50,000.00. WHAT IS WRONG WITH US AMERICA! We need to have compassion for our fellow americans by helping them see that enslavement to the government just leads to unproductive and meaningless lives.
Dan, Thanks for all of your efforts. As a physician constituency, you provide the nidus to crystallize our sentiments and suggestions. As a large group, we are forceful and influential. Kudos! John Vander Woude, MD, FACS
I back the appeal. Clearly it can't say everything with the detailed issues and experiences we've individually and collectively have but I believe that that no single formal medical association has sufficient knowledge to assess a true healthcare reform. As a pediatric subspecialist, I belong to more than one professional association but I don't belong to them for their ability to speak to or globally address all the health care issues. They can highlight and speak to some but even within the organizations, each of us knows, there are many different practice settings and challenges beyond our individual knowledge. What is cited in the Sermo appeal is pretty much, however, the common experience of those who are not sheltered by the rare employing entity that passes the pain of the issues to others in the organization. Note, I say rare, because for the most part many of the supporting elements' staff of those employing entities do get overcome and then the problems are further heightened for the physician: disparate supporting elements making disjointed "fixes" that affect physician's clinical focus, efficiency, productivity, and expand liability concerns, to say the least. My experience span federal healthcare, academia, general pediatrics in smaller community setting to subspecialty medical center based care. At this point in my life/professional career I am setting out to do what I feel increasingly strong about---bring subspecialty care closer to the patient community, as much as possible, and the primary care physician --even though I have to do it on my own and out of my own pocket (which is not deep). The counter forces highlighted in this appeal are incredibly daunting, but I am encouraged that, at least in this forum, I have the best chance of being "heard".
Will sign. It's not perfect but most important it comes from Physicians. We need to use OUR voice and not let Congress and policymakers choose for "us".
1.OBESITY- if we can decrease this in our country think of the possibilities in decreasing money spent on healthcare. LESS HTN, Cardiac comlications, diabetes,amputations,kidney failure etc etc etc etc...... Let's help our primary docs, teachers,media educate our population.
If I could boldly sign as John Hancock on the Declaration I would, however in this electronic age, my computer signature should be no less,
PHILLIP CHARLES ZINNI III DO,
God Bless you Dan for your leadership, and God Bless and Protect THESE UNITED States.
I agree with the ideas. In addition, #5 should be a competitive public health option paid for by the for profit health insurance companies if their income is less than 3 times FPL(Federal Poverty Level). Or a Federally mandated premium rate for basic services offered by all private health insurers that has no pre-existing condition exclusion or termination. This will solve the uninsured patient issue who truly can not afford present health insurance premiums. We NEED more Fam Meds and IMs in our medical system.
We cannot count on the AMA or the government to reform healthcare. We MUST take it upon ourselves. Oncologists in private practice, at least a few years ago, could provide quality oncology care for their patients at a fraction of the cost that hospitals charged. Why, because doctors know better what works and what doesn't as opposed to hospital and government bureaucrats. We cared for our patients and that included their healthcare costs. There needs to be tort reform. My state is losing doctors since it lacks tort reform. I wish I was in Texas! Oncologists and other physicians are rarely in private practice any longer. Many have sold out their practices for fear of what was coming down the road in the healthcare climate. As a result, those who did have sold out their fellow physicians out of their fear. We need to unite and the AMA is not the proper organization to unite us. The AMA and AMPAC appear to both work by the same principles as the bureaucrats in Washington.
As for the comment above about good luck in the battle for justice; I hate to disappoint Sermo Doc 85, but we currently live in a country which has no justice. Trust me, I have witnessed our legal system first hand. If we practiced medicine like lawyers practice law, we would all be richer and have more dead patients. Do not forget, both the congress and the senate are comprised of far too many people whose previous careers where as lawyers. We CANNOT let those people make a single decision on healthcare in this country.
To continue building credibility and public understanding in the media world of 90-120 second bites, at every media exposure opportunity I would try to provide a framework for the four prerequisites for TRUE and SUSTAINABLE healthcare reform, as listed above by the Sermo Team, by describing them as:
"Four of several key components of an American legislative and regulatory "private market solution" centered on and driven by empowered consumers, not a massive, tax and debt-based expansion of the existing "government control solution."
Once these two brief and "bright line" descriptive phrases are introduced and understood by the viewers, it would be easier to describe the societal value of implementing the first approach and avoiding the second.
Two short paragraphs can then explain the rationale for choosing the correct option for meaningful healthcare reform.
Implementation of the "private market solution" option has been blocked by America's existing government control solution that is dominated by government and its special interest group lobbyists, private and public health plan monopsonies and monopolies and characterized by unsustainable diagnostic and therapeutic waste and billions more lost annually to criminal fraud and abuse.
Except for the Wyden-Bennett Healthy Americans Act, all of the current draft reform proposals in Congress would produce an exponential and permanent expansion of the existing government-driven, unsustainable system.
America's founders would have appreciated the consequences of enacting the wrong option into federal law:
"To preserve the independence of the people, we must not let our rulers load us with perpetual debt. We must make our election between economy and liberty or profusion and servitude."---Thomas Jefferson.
I am carrying a copy of the appeal to Alabama Senator Spencer Bachus (R) tomorrow morning. He is meeting with a small group of hospital admin and physicians to discuss true reform.
I just read on a Pro_English website that the bill MANDATES that doctors provide free translation services for non_English speakers. How are we supposed to cover that overhead? And can we turn-away non_English speakers?
AMA is a CLUB! It is a lobbyist group not for physicians at large but physicians who think their way. Saying AMA represents all doctors is like saying the republican or democratic party represent all of america themselves. The reps for AMA are not voted on democratically, they meet at meetings and elect those they know at close door meetings. If not, they should send out ballots to ALL docs, not just those who pay dues and go to meetings. Some of us can't AFFORD to go all around the country as a part of a club- nor do we have the time off to do so!
Agree. A 95 yo pt told me the other day , "We don't have a health care crisis, we have health care financing crisis created by insurance companies and the legal system. Why don't we reform them?" Amazing how some people outside of these institutions are able to see clearly.
Exactly right. Tort reform as per Texas will not decrease cost of medicine so #1 is a false claim and it starts off this "appeal". Looks like all doctors care about is getting lawyers off their backs. Real "tort reform" is tort elimination, coupled by physician participation in a government run adjudication of health injury claims with NO lawyers involved at all, coupled with a review of ALL health injury claims by the Feds AND the State Medical Board to determine how the practice of medicine can be improved coupled with a promise by physicians to work collaboratively to decrease cost of care by 30% while continuously improving the quality of care as demonstrated, in part, by a progressive improvement in the health injury claims record of a state.
Like it or not for true health care reform to take place there must be:
1) a Dr-patient interaction supportive Public Option
2) a Dr-patient interaction supportive AND democratic access system for health care injury claim adjudication that is government run, no-fault and abolishes the tort system as the means of adjudication
3) a Dr-patient interaction supportive physician reimbursement system
4) a Dr-patient interaction supportive medical education system that does not debt load physicians who choose less lucrative primary care careers
5) a Dr-patient interaction supportive co-payment system
6) a Dr-patient interaction supportive EMR / EHR / HIE
7) a Dr-patient interaction supportive outcome assessment and feedback system with the goal of continuous quality improvement and continuous improvement in cost-effective care
You've got my support, I've signed with my real name. I agree tort reform is paramount in this reform, and maintaining the doctor-patient relationship without interference is imperative without government interference or influence.
Our issues will never see the light of day unless we can make the issues in this bill our distilled and reduced to language that everyone i.e. the general public can understand.
So far what I see is talking points that do not separate us from those who are this so eager to pass this bill.
How many of you have reviewed the bill?
I haven't but as of today I am going to give up some my "free time" and reviewed the entire bill.
The site is no longer at my finger tips but I found it and bought the transcript (every page ) for 35.63 bucks.
I agree completely about tort reform. Without it we will always be in a catch-22 mode and no change is possible.
However there is no doubt in my mind that either indifference or greed are the root cause of unnessary tests and treatment. I know I see it everyday.
Where we have failed is in taking an active role in using common sense in treating patients who would be better off in hospice but instead are in ICU's eating thousands of dollars a day.
Either we begin to honor our oath to our patients to first do know harm or someone will take the responsibilty from us.
Enough rhetoric! Read the bill and let's start being our patient's advocates and make sure that our decreasing reimbursements while our abilty to care for patients is being comprimised is no longer acceptable as the status quo.
Remember the Movie Network News?
Well I'm mad as hell and I'm not going to take anymore.
Start writing letters to the local newspapers. Let the folks know what's going on.
I do everyday with my patients while in the office.
We are essentially screwed no matter what happens.
If no changes are made, we are still stuck with this shitty system.
There is NO WAY our compensation is increasing unless we do something radical.
Thoughts from a totally fed-up booger-picking, ear wax-cleaning doc:
1) Cash only - why the hell are we helping ins companies pay for patients care?
I don't remember going to the grocery store and getting ANY grace
period to pay the bill!
2)Going bare - why the hell are we making defensive ins companies rich with exorbitant premiums and malpractice/personal injury attorneys wealthy by tapping our
policy limits?
3)Let's have a good old-fashioned WILD-CAT STRIKE! If all physicians strike for 3 days and only take care of true emergencies, we can cripple the system and then everybody will start listening to us! anyone in?
Kevin J. Donnelly,M.D.
Tampa, FL
Marked answer by mistake and cannot change to not vote, vote against, or add another choice. No mention of medication cost control, pharmaceutical industry regulation. They spend billions in direct to consumer advertisement. Read somewhere that for every dollar spent in DTCA the price of the drug increases by $2.50. Whenever I inquire about costs to drug reps: "for patients with insurance the copayment is 'only' ... And we have this rebate card, etc., etc.". So what happens when insurance co's pay millions, billions in medications? The insurance premiums for EVERYONE go up. Some form of control of pharmaceuticals, in my opinion, is an essential part of health reform.
FREE THE PEOPLE !!!! to make their own decisions with their DOCS
REAL insurance is NOT maintenance coverage... TORT REFORM as legal system merely goes for YOUR broken leg is now not perfect....bad doc!
LET INSURANCE COMPETE IN ALL STATES so as job changes, Insurance can go with YOU... unless you can get bettter after relocated... we do not live in single states anymore. and many states are incapable of building jobs as they tax new jobs out of existence
and competition will bring down costs... IN NY state where they put in community ratings HMO, the cost is 2 1/2 times greater for BLOCKED LIMITED ACCESS insurance in contrast to FLORIDA where PPO insurance with deductible and copay is BETTER insurance and (surprise) works thruout the ENTIRE state!! and not just in 3 counties as in NY state..
UNDERSTAND that the ONLY REASON we are in such a MESS is BECAUSE of GOVERNMENT MEDICINE no longer paying for much and forcing cost onto the PRIVATE SYSTEM..
DEAL with the REAL COSTS OF INCREASED premium : legal abuse, government intrusion and building up of paid czars and workers who do NOTHING TO HELP but constantly put on award banquets to reward themselves for nonproductivity!
I have informed my patients that the AMA represents less than 25% of the physicians in the United States. I want them to know that when they hear: "The AMA supports [proposal]..." it does not mean that physicians support that legislation. We cannot allow the administration to misrepresent us to our own patients. In our offices, we have the "Bully Pulpit" which can be used with patients that inquire about the issues and are interested in listening. Of course, however, we cannot be too bold and cannot press opinions upon patients who are uninterested in the legislative issues and who are, rightfully, in the office only for care.
I'm in. I think more could be said in the appeal, but I also think that it is critical for us to be another voice- and rightfully the true voice- of medicine. Tort/malpractice reform Insurance reform Patient responsibility and accountability (I know this last one is probably not politically correct, but I really think more needs to be said about it) Physician and patient driven- not bureaucratic government- medicine
Dan, no one dislikes CPT more than me. But...what do you have in mind for an alternative solution. I don't think the Payors are going to go for the wild wild west like the early days of Medicare. I saw what that caused and HB3200 is the current result. Unfortunately we docs took full advantage of the system and suddenly started living in half million dollar houses. We are hoist on our own petard and need to come up with a workable alternative quickly that will be truly convincing. The only true reform would be to eliminate the usual and customary type of medical insurance which encourages overuse of the medical care system on all fronts and replace it with a true market system that allows physicians and hospitals to vie for business with competitive pricing and quality. This could be done by having an insurance safety net with an extremely high deductable (much higher than you see now) for major medical coverage and tax-free health savings accounts. Tort reform would help also. Medicare could continue for a defined period of time to cover the geezers like me who would not have a chance to save anything before that last expensive surge in costs that we tend to incur. When people start looking at doctor's and hospital's fees before buying, no other force will be needed to control costs. Quality and cost, quality and cost...
in with my real name.
in by going to millionmedmarch.
in by mass mailing to congress.
in by talking to patients & colleagues and trying to get *them* to write/call/agitate.
in, in, in.
way too mad to just vent here.
nothing like a pissed off, menopausal, educated, p.r. mom of 7!!!
I am surprised at some of the other online forums. Very different from this one. Just looked at CNN.com and read some of the threads about healthcare. Is very pro- public option and reform and everyone seems to think the best answer is to decrease physician pay. Maybe we should all spend some time leaving comments on some of these sites too. Anyone know of others?
Please see the posting "Give Me Your Key Thoughts to ask my House Representative" Consider inviting your congressperson to your practice, make your voice heard.
Remember, we are one million strong- each of us caring for masses of patients per day. Make your congressman/woman's contact info available in your exam rooms, for patients to take with them. This could generate hundreds of thousands of calls per day from constituents which could actually make a difference. We CAN be heard, it is not too late.
I am outraged that none of the criticism of the current problem (as presented by the administration or any legislators) has addressed the enormous burden physicians face in order to get paid. The ordeal of submitting, resubmitting, and appealing unpaid and underpaid claims takes much more time and effort than the provision of medical care. The insurance companies are so powerful and have imposed such unfair rules. This must be changed, and I support all efforts to address this.
Dan, thanks for pulling docs together and helping us speak. Unlike the lawyers, we're inherently bad at this and that's why we've been taken advantage of by the "system."
keep the governmet outof medicine..Obama wants socialized medicine and to run the USA further nto bankrupsy..He should be recalled for putting our country into a weak and bankrupt position..
keep the governmet outof medicine..Obama wants socialized medicine and to run the USA further nto bankrupsy..He should be recalled for putting our country into a weak and bankrupt position..
Physicians need to be united in all matters concerning other physician groups. We worry about nurse practitioners, PAs and others being designated as primary care providers yet some of us close our eyes and even support psychologists, social workers etc prescribing medications for psychiatric patients. Wake up folks, if you think your specialty is protected form this usurption of medical powers by non physicians , please think again. We as physicians must speak with one voice and on that note, I propose that we do not fight with the AMA but see how we can all work together for the common good of all Physicians especially regarding the current healthcare debate.
Recently my health insurance went up 75%.( Health net) . I'm a solo practitioner.
When I review the increments in reimbursement from that insurance as a doctor it ihas been only 10% in the last 7 years. Are there any regulations to that sort of injustice?
Physicians should speak up for the sake of our patients who are the ultimate victims of lobbyist directed health reform. It is time for Congressmen, Senators and the President be true to their word rather than hide behind the spin or title they can put on a bill.
If this is to be a true health care reform, it should address all the deficiencies of the system rather than pick and choose the items depending on the political or financial strength of the lobbying group that benefits the specific change.
One significant cost of medicine is Medical Malpractice and TORT reform is NOT being addressed or mentioned. From the cost of malpractice insurance, additional test to cover possible malpractice and the defense of unnecessary claims, the high cost of medical malpractice is borne by all of us except for a few that financially benefit from pursuing unnecessary suit.
I think that it is a bit too passive and not specific enough.
True healthcare reform will only succeed if:Â
Unnecessary tests and procedures are reduced through tort reform, malpractice reform and the use of nationally established evidenced-based guidelines for problem management.
Insurance billing is streamlined and simplified to make pricing *completely* transparent to patients and providers.
Medical decisions are made by physicians and patients.
Reimbursements are determined by a fair and objective system which takes into account cognitive skills, procedural skills as well as the time invested in the patient's problems. (This is probably the hardest one to define... what do you charge for and when?)
Dan, thanks for all your hard work and initiative during this time of health care crisis. I'm glad you and Sermo will represent us with the AMA is busy representing their CPT interests and the insurance companies which use them.
I seek the elimination of CPT codes completely, elimination of insurance companies, elimination of any sort of socialist health care delivery, elimination of malpractice lawyers, and re-emergence of a capitalist medical practice model where doctors can set reasonable fees to be paid by their patients whether in cash or in chickens (barter). I seek a financial and legal environment in which Physicians can provide true charity care to those in need not by force of law (ie. Medicaid/Medicare/Obamacare), but because the Physician has time and money to provide charity care at his or her discretion.
I support the petition wholeheartedly but since when is Medicare equal to charity care? I treat patients who are covered by Medicare and I have never done so "by force of law". By the way, "socialized medicine" means the government owns/runs ALL HEALTH CARE which includes hospitals, clinics, surgicenters, labs, etc. and employs the physicians, nurses, therapists everyone directly in providing health care. Having a government run health insurance agency that provides affordable care is not socialism.
Sermo Doc 25 Family Medicine is correct. You need a strong PCP network to cut down on this procedure oriented medical services.
dnh002 Infectious Diseases Posted Aug 17, 2009 at 4:05 PM
Sermo Doc 25 - PCPs in all other countries with socialized medicine make even less than American PCPs. In the eastern european block they drive cabs for spending $. - We also have socialized medicine !! which is actually run by private insurance companies dominating the market. Canadian doctors actually make more than the US conterparts, but they do payback more in taxes.
Sermo Doc 223 Cardiology wrote
Having a government run health insurance agency that provides affordable care is not socialism. - -thank you for what you said. Do not let the insurance companies discriminate the sick by denieng coverage when they need them most.. We need insurance reform, tort reform and a public option.
Why don't the lawyers have any skin in the game? There is no tort reform in 2000 pages of nonsense. All physicians practice defensive medicine which drives up costs. If we had a set of parameters we could use on common cases that would be defined as the standard of care we could reduce costs dramatically.
i proudly support the appeal and signed it instantly but this will not be enough. we will need to prove to the government and the american public that WE MUST be in control of this effort. unfortunately it may require a more unified statement if you know what i mean. we should prepare to take the appropriate steps to knock this one out of the park. we have always had the control but we were too damn divided to make a difference. once we prove to them that healthcare for all is a privilege and not a right then we can change healthcare in this country. the american public will stand behind us when we stand up and do what we have to do to right this ship. ALL ABOARD!!!!!!!!!!!!!!!!!!!!!!!!!!
It's about time that physicians stand together on common ground and fight for our right to practice medicine the way we want to practice medicine. I am definitely in support of the appeal.
I agree with pprior about the slap in the face that it was for the President to not address malpractice reform. This is absolutely critical to the success of this issue, not cutting reimbursements to hospitals and putting physicians on a salary. Thanks Dan for smacking Howard Dean around a little as well.
1. Adequate fees for service established by a physician panel
2. Establishment of Medical Courts. i.e Malpractice cases judged by physicians and physician juries (Peers!!!)
I signed, mostly because I think tort reform is so important, but am dismayed by the knee-jerk reflex among some in here that the Obama administration is the enemy and Republicans are your friends. www.nytimes.com key graph: "The American Medical Association has long battled Democrats who oppose protecting doctors from malpractice lawsuits. But during a private meeting at the White House last month, association officials said, they found one Democrat willing to entertain the idea: President Obama. In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials."
Obama put malpractice reform on the table, said "I'll give it to you" and Repubs walked away, more interested in scoring political points than doing what's best for the country, and for doctors. They're more than happy to take your donations promising to do something, but when it's actually offered they walk away (I think they believe if things actually change, the teat will dry up-- there's more money to be made in agitating against the status quo than actually doing something about it). Stop being partisan hacks and recognize when someone really offers to do something to help us.
I agree with all of the statements but this appeal is not enough. If we don't want the front line of our profession manned by PA's and NP's then more needs to be done to improve reimbursement for primary care. As far as unnecessary testing, Malpractice reform is important but we need to self regulate as well. How many unnecessary echos and stress tests are done just because they can be and can get reimbursed? Why is the reimbursement system so procedure weighted? What is the thought process involved when I can spend 30 minutes with a patient counseling them about their cholesterol or diabetes, get reimbursed 50-70 dollars, assuming they are not capitated, then take a little skin lesion off them in all of 5 minutes and get 90-100 dollars for that. That's a small example that affects me directly, but what about the 1000 dollar plus reimbursements for other procedures that take very little time. This along with limiting profits of the pharmaceutical industry and the insurance companies is where to save the most money. Unfortunately, given the Lobbies out there, there is little chance that malpractice reform, Pharmaceutical and insurance industry profits are likely to be a key component of reform.
Those of you who think Medicare does not force you into complying with the government, should look at what the rules are to try to leave Medicare. It is so incredibly punitive to you and the beneficiary so that it is virtually impossible to leave.
You don't have a flexible system unless it is run as a market. THere is no innovation unless there is little governmental control.
When did someone offer you a reasonable rate to speak with a patient on the phone, the internet, or simply monitor labs which are important to health.
What? You can't see the forest for the trees? NAAWWH.
Spread the word... the following is an email I sent to colleagues, friends, and family. Please consider doing the same. Feel free to copy and paste and send.
Hello to all,
1. I ask that you share this with as many physicians as possible to get them involved. 2. I also encourage you to share this with everyone to further educate each one of us to help ensure that any "reform" is actually worthwhile.
There is a website for physicians that serves as a network for addressing clinical issues and other healthcare matters. Dr. Daniel Palestrant who founded the site, as well as many of us member physicians, are interested in true improvement of the healthcare system.
There is an appeal for physicians to sign to be more involved in the plans for healthcare reform in order to achieve a system that allows for the delivery of quality medical care. I have signed it myself.
Not good enough. We're still talking with our pocketbooks. This gives lip service to improving access and quality of care, but the specifics in this "appeal" are geared toward financial reforms which mostly benefit our profession, not those whose real needs represent the only moral and compassionate reasons for reform.
This appeal does not address the 40-50 million uninsured Americans, many of whom will never be seen as patients because so many of us refuse non-paying or Medicaid patients. I don't see anything suggested here that will affect the 50% of U.S. bankruptcies attributed to health care costs.
The "bullet points" are answering the wrong questions: Why does our "best in the world" country rank so low for longevity, infant mortality, children's health, and overall cost effectiveness? Why does bankruptcy caused by health costs even exist in the richest country in the world? Not because of CPT codes or tort reform. Our entire system of health delivery needs to be examined and compared to those of the industrialized nations which have successful systems. Until we can get beyond our own financial self-interest and our cultural blindness to these facts, real health care reform is but a dream.
Healthcare reform is not equivalent to health insurance for all. I have patients that have health insurance but because their deductibles are so high they still forgo preventative procedures everyday because of the cost. MAlpractice insurance has forced many good doctors out of medicine, not because of lawsuits but because their sky rocketing premiums made continuing to help their patients impossible. True healcare reform will never succeed without reform of the whole insurance industry. Health and malpractice insurance reap too much of the healthcare dollar without providing anything back on the investment. WHen will the politicians stop thinking with their campaign cofers and realize that the insurance industry has bought them lock stock and barrel without giving the average patient a second thought.
Sermo Doc 238: I agree completely. The current U.S. insurance "industry" is the equivalent of a giant Ponzi scheme, with political buy-offs and a protection racket built in.
The main beneficiaries of this "industry" are shareholders, corporate officers, and paid off politicians. The patsies in this scheme are the government, private businesses, and employees, who pay and pay and pay for this mess.
I agree there is need for some reform. However the present reform they are offering is going to ruin us all. They need to discard the present bill and start all over again to include most importantly Tort reform, Abortion issue need to be discarded and also the death panel issues.Obama should stop insulting us and blaming us for the high cost of medical care and claims of poor quality of care we are offering. I hope AMA would protect us from this libel
Please fight for family physicians, without us subspecialist will be doing all the primary care through their hired PAs. I was reminded that my colleague in ENT is so much better reimbursed that me as family doctor (who does comprehensive care and coordination of care) as his rates are higher and he charged $150 to "surgically remove" a small piece of wax from my ear.
Subspecialist who have dominated our medical societies and special interest groups have fought through the years to keep their reimbursements high while those of us in primary care only receive about 55% of subspecialist income and yet our work is more comprehensive and our overhead at every level is higher.
Individual medical specialist have each fought for their own specialiites and the importance of such and the reimbursement while family physicians have been the most benevolent and only in the past few years have gotten themselves postured in a more aggressively.
I am appealing to the 70-80% of subspecialist on behalf of the 20-30% of those of us primary physicians to value us equally and fight for all MD/DOs board certified to receieve fair and equal reimbursement. Yes, we recognize that your residency training is longer, but you are responsible for much less of the total patient care and if you continue to let primary care die, you life will become immensely more difficult as your patients will be looking to you for their detailed and time consuming questions and coordination of their care and their multifacited primary complaints.
If primary care dies, you subspecialist will be reassigned this duty by society and government and your focused care and outcomes will become less effective and less enjoyable. Such unlike the AMA and its members and the weak representation of primary at that level who had no objection, you can pay now or pay later to save primary care by being willing to have at least a small percent of your procedural reimbursement shifted to your patients family doctor and their medical home. I challenge you to step up to the plate and support all doctors that go through the same medical school that you go through and choose to serve society through the board certification of family mediclne or general internal medicine, even if the residency is shorter, we are still co-laboring with you and working just as hard and our work is KEY to healthcare reform and you being able to continue to be a proceduralist and and "subspecialist". Please reconsider and reach down and fight for us and show our government, health insurances and policy makers you value our services by "tithing" a 10% of your remimbursement back to primary care to help us get on equal footing. Please don't be like everyone else who expects us to "make bricks without staw". Thank you for considering to help. Sermo Doc 241
Thank you very much for your new initiative - again, Dan.
Signed with real name, of course.
You could have added that the third party payer system is the source of most problems. Only when patients watch and monitor where the money is going will we have true cost savings.
One great solution would be: HSA with basic preventive measures such as Pap, mammography, colonoscopy etc included in plan coverage.
Thank you, keep going
I find your comments exteremely ignorant and degarding to physicians. As an ENT and Head & Neck Sermo Doc 102, I have never decided to remove a child's tonsils for financial reasons. If I was thinking financially I would keep seeing that child in the office every month for tonsil infections and charging $100 per visit till the end of time rather than take out that child's tonsils and hope to get $300 with 3 months postoperative care included. You need to get your facts straight and realize that insurance companies and pharmaceuticals are at the root of your rising healthcare dollars. Once you gain some courage and learn that reform comes with insruance reform, you will make some headway. The public option is not an option in this country just look at the VA system and how incentivized the doctors and nurses are in those settings.
It is still interesting to me that so many physicians support the appeal, but sign their name anonymously. What are they afraid of? Obama's retaliation? No, really?
Sermo Doc 20:- I think you are quite right and, therefore, it may take 2 or 3 generations of medical students/new doctors to make a difference in cost, but I think tort reform and education of patients' expectations are essential for cost control. I support the appeal.
My Senator is the illustrious Harry Reid. I hope he listens to us. Put my name on it, I would welcome a chance to sit down with Harry and set him straight. What the H*%& was the AMA thinking when they supported this charade? They surely did not ask my opinion.
I believe in a strong united front for physicians. I think it can only be done with one voice and that would have be like a union like labor unions One for all physicians and a strong lobby and the right to refuse care except in emergencies until our voice is heard loud and strong E.J.Brotman Sermo Doc 408
I support the appeal. Tort reform and billing transparency are key items for me. Pts need to see how little we are paid and understand the risks we take to care for them. I was a private practice solo gastroenterologist. The changes that have been taking place the past few years will make solo practitioner extinct !!
pls see
docs.google.com the German system may work well for us, tier costs and services based on expectations and level of prevention desired with krankenkasse, sickness funds, like co-ops, competitive as even soccer clubs have them, and reimburse naturopaths, herbalists and the like.
Do you really want to make a change? Start telling your patients why they should watch closely what their elected officials are doing and clear out those whose actions are with their special interests only. Think about the staggering number of voters we can reach. Perhaps then our government will listen to us more closely. Tort reform? Sure, but why not reform the entire system? We need to restructure our government to be truly representative of our society. I don't think Americans are 70-80% attorneys. Encourage your voting patients to remove the incumbents and make a real change.
I agree with Sermo Doc 98 about balance billing; since Medicare is not able to pay physicians what we are worth let us bill the patients for the balance. Let the patients know Medicare is not doing them right; maybe then the patients will see the real Medicare.
I think we need to be honest about the cost of medicine. We need to do the best we can but the cost is NOT going down. We have a huge population entering Medicare age and the current medicare population is living longer (and better because of access to medical care.) So any discussion of reform needs to acknowledge the fact that cost is going to go up if we successfully treat more people. Right now Obamacare plans (as if they really have any clue) to ration care and I am sure, decrease physician reimbursement. We need to stand up and point out exactly what we do and why we need to be reimbursed fairly.
Dan, I hope you will include the comments from this site along with the petition. It would be educational for our legislators to review the issues generated by thoughtful and involved health care providers who are the ONLY ones who can really effect the needed changes in the delivery system and lower the price tag in a rational way.
murali, I agree with you 100%!!!!!! The term provider was introduced by the insurance industry and only serves to diminish us. Language is a powerful way to change the public's perception. We are physicians and Sermo Doc 102s, professionals who have education and training unequalled by any other practitioner who cares for patients. We need to change this and insist that we are referred to by our appropriate titles.
I have signed. How can anyone be taking this President seriously? The inaccurate information that he is spouting at "town hall" meetings continues. The funny thing is that the administration/propaganda machine tells these lies (ie surgeon making $30K for a foot amputation) and NOBODY SEEMS TO KNOW THAT THIS IS OBSCENELY WRONG! On the day that those comments were made (or actually the day after), the comments on various blogs and websites (glenn beck, cnn news) oddly had their focus simply on whether or not physicians perform procedures for the payment-regardless of the particulars of any individual case! My point is that with the media not completely understanding what is going on regarding the issues of health care, physician reimbursement, etc., AND this same media giving Obama a free pass on most legitimate criticism, there is no way that most Americans will be able to comprehend the complexities of these issues.
I agree with Sermo Doc 74--TORT REFORM!
By the way, I hate the term "provider". It denegrates our profession. So, I add my support to the previous additions to the commentary.
let's find other online forums about healthcare and leave lots of our comments to help educate the public. We could even copy and paste some of them from Sermo. (remember to call us physicians, not providers. Could refer to PAs and NPs as mid-level providers?)
Otherwise the general public might continue to support the "propaganda machine." And they will continue to think that the only reasonable way to reduce costs is to reduce physician salaries - I've read this idea multiple times on these sites.
I took a year off to practice for six months in New Zealand and six months in Australia. What a relief it was to spend my time treating patients, unlike here in the U.S. where I spend about 30% or more of my time with patients and staff discussing insurance problems and trying to get medications approved or how to come up with alternative but not-as-good treatment plans. Then at night we talk about how bad we feel millions of people are getting no treatment. I know a single payor plan goes against the grain of "American autonomy," but how much longer can our people suffer? At least a public option is heading somewhat toward a workable system. Must we crash and burn more before we balance our love/embrace of autonomy with the greater need of all our people?
Without meaningful tort reform we all know too well -- the "rule-out mind-set" and the accompanying imaging, labs, and procedures will continue to increase costs. Society must again trust the cumulative experience of their primary care, ER and specialist physicians. The lay public and their lawyers have created this mess, and both are "protected classes" by this administration and congress, so that real reform is unlikely.
Signed my real name. I have asked friends who are fellow physicians to join Sermo. None of them are AMA members, isn't that interesting?! They all feel that the AMA has completely lost touch with physicians who they are supposed to represent.
Ramstrong "Language is a powerful way to change the public's perception.."
For our own cause, we need to make sure we are addressed properly in interactions. We need to use the same persuasive reasoning that annihilates anyone in the US who calls someone a "Nazi" , "Negro" or "Communist" Try addressing a letter to a lawyer without that meaningless "Esq"!... Other areas for remedial physician education: 1) Ask for "NO FAULT INDEMNITY" NOT tort reform. Don't just blurt out media blurbs. 2) Demand that people who work with patients not be identified as Doctor unless they have a formal medical education. This includes optometrists, Pharmacists, PAs, NP and DNPs.
I've no problem with abolition of third party insurance system, abolition of medical malpractice system, elimination of subsidies to hospitals and drug companies for treating poor people, abolition of Medicare and medicaid, abolition of free drugs from drug companies including samples, abolition of minimum wages, opening the US market to outside competition but only on an absolutely level playing field and letting the brutal market forces drive down costs. If all these do not happen concurrently, there is NO reason to scrap the current system and create a big obamamess. NO! It won't be a wild wild west. It will lead to attrition and death of the blood suckers and leaches who live off of hard working doctors..
Tort reform, tort reform, tort reform! If the cost of health care has gone up exponentially, yet some physicians can now barely pay afford to pay their own bills, then physicians certainly aren't the cause of this problem. We can easily save $200 billion/yr with meaningful tort reform, too bad it won't happen since Washington is run by lawyers.
Please understand what you are asking for when you demand, "Tort-reform". We really need to make sure it is a no fault insurance...otherwise, we may end up with "Tart reform".
It has been shown that there will be NO changes in insurance premiums if you simply do tort/malpractice reform. Insurance regulation HAS TO accompany tort reform/malpractice reform.
Excellent start, but perhaps lacking some specific insurance reform requests (portability / no one turned away / etc.)...and some medical system reforms (promoting competition from within our own medical family ranks, which is something some physicians simply do not want to consider).
We must not ask for reform effort contributions of everyone else but ourselves. We should be able to provide high quality care, second to none, for less $$$ if we are willing to rework some or our own 'ways and means'. How about we develop a system that promotes "cross training" and "additional educational opportunities" in areas where our basic prior medical training provides appropriate foundations for our learning new things and providing our patients with new care options.....without having to go back and go through a second residency? Cut out the turf walls where they are medically unnecessary and are merely business walls. See...I told you, many are not willing to consider this "inside the system of medicine" change. It would promote competition that many do not wish to have. We protect our own turf / system...and ask every other component to consider real change...so that costs can come down, but care can remain superb.
We should, at the very least, consider these changes together.
If there is no meaningful tort reform doctors will find a place where it is reasonable to practice medicine-even if it means going to Australia !
Tort reform will bring down by decreasing the cost by 30% atleast!
nobody, even president does not openly speak about tort reform, law suits and bigger and bigger malpractice rewads granted by uneducated juries are the root cause of breakdown of healthcare system.
Signed. Sermo needs to be more visible in the news so the public can see that there is much more than the AMA. It is getting more frustrating by the day trying to give any kind of adequate care.
Insurance premiums and defensive medicine have no correlation. Fear of hassles of unmeritorious lawsuits drives up costs of defensive medicine. We need to stop talking like "talking heads", be analytical and explain the issues correctly to the public and to the politicians. I doubt that Pres.Obama or our Senators have been educated about these issues correctly. He is surrounded by a fortress of special interest groups. The institute of Medicine needs infusion of brainpower from practicing physicians. They are responsible for sensational statistics that can drive up costs.
Listened last night to the one hour conference call led by Kavita Patel a formerly practicing internal medicine specialist and David Semus(sp?) of the White House Communications office, with more than 2000 docs on line. I took voluminous notes. From my point of view, the priorities of the White House were clearly deliniated;
Insurance Reform consisting of
No exclusion for pre-existing conditions
Limitations on out-of-pocket expenses
No lifetime or annual caps on benefits
Eliminate Co-pays for preventative care
No loss of insured status due to occurence of a disease.
They stated a clear and specific desire to eliminate the fee for service model and pursue a Global Payment system nationally.
There was no mention whatsoever of tort reform until a specific question was asked about Obama's amputation quote, which they did not disavow. They see lawsuits and defensive medicine as quality issues, because clearly if doctors just used best practices and bring up the quality, lawsuits wouldn't be a problem. They are opposed to caps, and made no mention of review panels or expert certification.
There was no mention whatsoever of a public option.
End of life care issues are likely going to be deferred to later legislation, perhaps after more conferences
What we should be fighting for is a Medicare-For-All single payer system; everybody in, nobody out. Only with this firm foundation can costs be controlled and meaningful reforms, including tort reform, be instituted.
Sermo Doc 25, we as surgeons lose money when we go to the OR,medicare has effectively de-insentivized any surgical procedures. Unfortunately, we would rather be in the office these days!
@ Sermo Doc 185 - No, you don't wish you were in Texas. The tyranny of the malpractice bar has been replaced by the even greater tyranny of the Texas Medical Board. Tort reform still needs some tweaking down there.
What happened to old time personal responsiblity? Patients no complain of any cost out of their pocket. Most government programs have no personal responsibility involved, and then reimburse the physician so poorly he can't see the pt without losing his shirt.
If the pt had to pay a portion, and had individual policies rather than employer purchased ones, a competitive market for such policies would develop. Same way with meds--without adequate numbers of patients willing to pay a designated price, the company cannnot sell its wonder drug prices would come down. (of course on pharma's side, we'd have to lengthen the patent time or have it run from the time it hit the market, not years before). I'm happy to sign the document. It's good to have a DOCTOR forum. I liked DR. Tofflet's post especially . Marilyn Janke MD
How does one remove the insurance functionary from decision-making while also expecting a third party to pay? If this happens, premiums will assuredly skyrocket, unless intelligent insurance reform takes place. How is this to be done?
Are pre-existing condition exclusions to be outlawed? If so, are healthy people to be required to buy insurance? How much insurance? Will this work? I'd like to hear from an expert on insurance what would be required from the healthy populace to make this work.
"Revising methods to calculate reimbursements": there's nothing specific in this to help those of us who are nearly out of business, i.e., E&M physicians. This is why the AMA has been useless for E&M physicians. They are too scared of their procedural members to advocate for E&M practitioners in any meaningful way. Does it mean pay E&M more? Or does it mean pay everybody more? Nobody will listen to that.
Signed, with my name. Regarding CPT.... how about we just use ENGLISH? Everyone can read it, only the untrained even have to look anything up. Last time I checked, there was no CPT for "trauma to the ______ extremity with subsequent pain, swelling, discoloration, limited ROM and possible deformity of the boney structure (although exam is limited by swelling)". Right? All those clinicians who beat me up in training until I could describe everything in glorious detail must have been wrong. It can't even be "suspected fracture", just a number which stands for a symptom, occasionally "modified" with another number that also stands for a symptom. In my book, plain language would be sufficient. I have to look up CPT codes, myself! Then explain them to the high school graduate with no particular medical training or background so his employer (the insurer) will pay the poor patients' bill.
My solution would be to ensure that everyone has a MSA, and pays their own bills. Let us all compete for customers (patients). It would work. Even the vilest, least compassionate physicians I've known have generated a following. In our rural area there are inpatient facilities in every direction, all within a 35-60 minute drive. My patients routinely choose where to go based on which facility will do the best job for the best price. Sometimes they choose a more expensive facility because it is better at whatever is being done, but if it's a simple proceedure, they will go where it's cheaper. Did I mention most of my patients pay for their own health care? They also generally ask my advice when they are making their decision.
I also would be happy to be paid less, if it meant less expense to run the business, and less time spent buried in paperwork (computer work). Oh, to have more family time!
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Indict corrupt Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition! Allow interstate sale of health insurance with more competition, lower premiums, portable policies, and better deals for docs.
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills.
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
6. Don't fall for Obama's Global Reimbursement Plan for private Insurance. It's just shifting Medicare Reimbursement to private co's, a modified Public Option. Other ammendments will cover emploers' HSA's, rationing of high paid procedures and other care, and death Panels.
Inform your patients who vote, the media could care less as they love B.O. who seems to be much slicker in modifying his Public Option.
Will Doctors Opt Out Of A Public Option?
________________________________________
Date: 2009-08-26, 7:10PM PDT Craiglist
Reply to: comm-ucahn-1344356949@craigslist.org [Errors when replying to ads?]
________________________________________
It appears at least some plan too. Dr. Alfred Bonati, who heads the American Society of Medical Doctors, says he plans to say "no" to accepting patients under a government run plan and, according to a poll he cites, so do an awful lot of other physicians:
Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.
Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient's family.
I share the view of the 60 percent in the August poll -- those doctors who are planning to "just say no" if government-run health coverage is implemented. Many of us already do not accept patients who are on Medicare or Medicaid because of restrictions those programs put on our decisions as doctors. It pains us to turn away a patient in need, but the narrow rules of government reimbursement programs stymie our ability to follow our oath, so we simply opt out and work with patients who are also in need but have more flexible, private coverage.
If a government option gains the popularity that is expected -- after all, who would not choose the most affordable option available, and how could any option compete with one that is subsidized by taxpayers -- millions of Americans will face severely limited options in choosing a doctor. As physicians reject working with a system that does not honor our oath, patients will be left opening their own checkbooks, or going into credit card debt, to get the treatment they need and deserve.
The law of unintended consequences again raises its head. The government may indeed put a public option in place - whether or not the citizens of the nation want it or not. And they may, through legislation, force insurance companies to take everyone without exception, but -at least not at this point- they can't force doctors to accept patients under plans that don't feel reimburses at a rate commensurate with the care given or doesn't allow them to treat a patient in accordance with the oath they took.
Of course that then leaves that system with a problem and the government with a dilemma - does it then force MDs to take anyone who applies (as it will insurance companies) regardless of insurance plan? And if so, how do you suppose doctors and other health care providers will react?
It is these sorts of problems, dilemmas and unintended consequences that few are talking about in this great "debate". What if it is doctors who become the Atlas that shrugs when all is said and done? What options would the government then have - in this land of the "free" and home of the brave?
I am a practicing radiologist and ever declining reimbursement is destroying our practice. We are being asked to do more and more, faster for less.....I am so very concerned that we are going too fast and have crossed the line where paient safety is at risk. We have lost the personal communication between patient and radiologist which is integral to the radiology consult. Furthermore, the intrusion of "radiology benefit managers" has further complicated our task.....we are allowing the doctor patient relationship to be destroyed, as clerks ration care.
President Obama talks about billions of dollar spend on "defensive medicine", & then no mention about "Tort Law"! How ridiciulous is this!
He wants to cut salary of physians but what about hospitals charge10-20 times for the procedure & what about insurance companies pay providers less & has very high health insurance premiums. Insurance comapnies are allowed to make money but providers should not.
Medicare & Social Security needs bail out, not car makers & not financial institutions..
campdoc Internal Medicine.........Medicare is held up by the feds as an example of a federal program that works...this practice of six hasnt accepted a new Medicare patient in five years!...any cuts, and we will quit Medicare for good...great program...
If we all get out of third party contracts and out from under HIPAA, we can practice medicine for our patients and collect our own charges at the time of service. ICD-9 and CPT codes are not necessary. My cash urology practice decreased overhead 75% by going cash only. I'm the most affordable urologist in the midwest. Anyone can afford me easier than they can afford any other doctor. I am not free, but I'm not expensive either. We do not have to whine to bureaucrats to make our lives easy. Take back our profession with pride and ownership...
GET OUT OF THIRD PARTY CONTRACTS AND PRACTICE MEDICINE!
Let me get this straight.
Obama's health care plan will be written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it and whose members will be exempt from it, signed by a president who smokes, funded by a treasury chief who did not pay his taxes, overseen by a Sermo Doc 102 general who is obese, mostly unConstitutional, and financed by a country that is broke.
What could possibly go wrong?
I saw all of this coming 6 years ago, after 10 years of practice and my income eroding year over year. I went home angry every night after fighting all day with insurance companies and managed care denial doctors. I quit, left the practice to my partners and joined the pharmaceutical research industry. It is terrific, 40 hour work week, decent pay and solid benefits, and best of all I am not angry anymore. Who is the loser in this game, ultimately the patients, my community lost a solid experienced psychiatrist in the prime of his productive career years. Well the public is going to have to do something about it before we are all gone.
When I computerized my office in 1985 the insurance company database consisted of 7-9. When I decommissioned that mini-main frame and upgraded in 1991 there were 435 insurance companies in the database. In six years the number of insurance companies had proliferated and our fees took a 10% drop during that period. No business can stay in business receiving 51-55 cents on each dollar generated. There is also no other profession whose fees are governed by bean-counters & lawyers. Beverley JP Edwards, MD
When I first strted practice, after leaving a medical school faculty, patients expected to pay , typically, 20% of the cost of their care, up to a maximum, before insurance covered 100%. Premiums were affordable for the vast majority, and there were free and part pay clinics for those who could not afford insurance. Patients were wise shoppers, and sought the most cost effective ways to get the care they needed. Now tha "managed care" has penetrated(pun intended) the market, patients can load up on cer for a relatively small co-pay, and do not really know or care what the cost is. That leads to waste, and spiralling increase of premiums. We need for everyone to share the responsibility of the cost. Let employers fund some percent of a private insurance policy their employees buy and get a tax deduction for that-not buy the policies. Give individuals TAX CREDITS for the premiums they pay, but return to a physician-patient relationship as to wht test or treatment is performed. Let patients shop for the most cost effective insuranc epolicy, and have cafeteria plans so that 50 year olds do not need to buy obstetrical coverage. If the government really feels the need to throw money at the health care system, let them provide grants to local communities to operate clinics with local medical directors help with managing the care-cost issues. The government should keep its hands off. The only thing I have seen our government operate effectively is our military.
You can't have meaningful reform without three things: tort reform, medical education reform, and insurance reform.
To my regret we haven't discussed medical education reform. I don't have anything original to add; most of what I believe should change has been suggested by experts. Everything we needed from calculus, physics, organic chemistry, and inorganic chemistry could be taught in six weeks without making it a weedout program. Everything we needed from biology could be taught in six weeks or less and incorporated into microbiology. Anatomy, physiology, biochemistry, economics, statistics, pharmacology, microbiology, biochemistry would be the new premed sequence (optional: a year of law), reducing med school to two clinical years.
We'd get out two years earlier and two years less in debt and we'd be better educated as docs. And we could have more doctors.
I would assert we would have more caring doctors as well.
Would it not be nice to stop playing Russian Roulette Fee Schedules with the insurance companies? Show me yours and I might show you mine? How about if an insurance company had set fees for procedures and services, and I could call, say I'm interested in participating in their network, and they send me the list of what they pay for office visits and my most common procedures?
We all know what it's like, but does the President or the public? If I submit a fee schedule to a company, and they agree to pay what I'm asking, I know I'm not asking enough. So, I raise my fees to the point that the companies don't pay me what I ask, and then I know I've done my best. Sadly, I then have to stick by my inflated fees with my self-pay patients or be guilty of insurance fraud. Meanwhile, the big practice down the street may be getting 15% more than I for the same service from the same company. And of course, I can't ask them what they get, because that's a violation of my contract with them. RIDICULOUS. And, I won't know what I'll really get paid until AFTER I've signed a contract. How crazy is this?
The key to reform is to change the basic paradigm of insurance. Now, employers provide insurance, and insurers pay providers, but unilaterally. The doctor and the patient aren't even part of the equation.
Eliminate employer provided insurance. Require everyone to purchase private insurance (like auto liability) and require insurers to accept all applicants. Require patients to pay for care and then seek reimbursement from insurers.
Admin and high demand are the primary drivers of increasing medical costs. Doing these things eliminates administrative costs (insurers will compete on efficiency and service, not denials and payment reductions, and providers can reduce staff substantially), and reduces demand (patients will think twice before opening their own wallets; doctors will no longer have incentives to overtreat for profit.)
There are a ton of details, but unless the basic paradigm is changed, nothing in the congressional proposals will rein in those two basic cost drivers.
I am a Sermo Doc 408 general and vascular surgeon (osteoarthritis and bionic below the waist). Living near the Onondaga Nation Reservation, and having had a good number of Onondagas in my practice I went to the health center which is quite a nice facility to see if I could help out. I knew the medical director and she was enthusiastic, after all, a free surgical service in an underserved population wasn't a bad deal. Unfortunately, the clinic is managed by a "community health center" who are government funded and are reimbursed on a "per diem" basis. I was able to work two days a week, but my offer was turned down. the reason? I couldn't generate enough income on a per diem basis to cover the cost of malpractice insurance. Even a minor surgical procedure is reimbursed the same amount as a 10" script renewal. I guess I could pay the community health center the difference to care for some needy patients but I think I'll pass on that for now and wait for this different type of "fee for service" (doctor pays government to treat his patients) practice to be legislated into existence. It isn't that far off reality.
I would like to hear why the health care community and those interested have not discussed a return to a straight fee for service practice with government catostrophic insurance. Get rid of the middle men and women, the fancy high rise buildings and millions of computers. Let doctors run medicine. Forty years of taking physicians out of the "provider"-patient relationship hasn't worked. Aphorisms say it all. 40 years ago, "if it works, don't fix it" They fixed it and now it doesn't work; and now "if it doesn't work, fix it". They won't fix it because of the embedded, self interested insurance infrastructure. I'm going back into practice as a micropractice and make my fee for my service work for my patients in my community.
These are laudable requirements for reform but I don't think they go far enough. It is critical that the new healtcare incentivize doctors to go into primary care by numerous means (ie - loan forgivness, better reimbursement for services). It is also important that a new healthcare plan incentivize doctors who demonstrate consistent achievement of standards of care. Finally, patients must be incentivized to lead healthier lives and should be rewarded for achieving accepted standards of wellness. Tort reform needs to be a centerpiece of cost control but so do reducing fraud and abuse in the healthcare system - particulraly through medicare and medicaid.
I can't sign this. I work in the ER, a place of high malpractice exposure, but these 4 principles are really off base. 1. Bring me the evidence that "real tort reform" will make a big difference in unnecessary test ordering. I practice in Indiana, one of the 5 best states for malpractice and one of the first to institute "real tort reform," and the reasons for over-ordering are much more complex than this overly simplistic formulation. 2. Hasn't anyone read the studies that show doctors are spending more time with patients now? Sure, it's counterintuitive, but I'd rather deal with peer-reviewed data. If you want to streamline billing, expand Medicare to cover everyone. 3. OK, I'm in total agreement with this, but it begs the question: why even keep the parasitic middleman for-profit insurance companies at all? And why is Sermo shilling for the insurance and pharmaceutical industries instead of fighting for our patients? 4. I don't understand this, but I've been corrupted by data again. Read the Dartmouth Atlas about physician supply. Docs need to be paid well, but why is Sermo mostly fighting for the rights of insurance companies and doctors' incomes? I'm well paid. I want my patients to have access to quality affordable health care. I don't really read that as the chief concern of folks signing onto these principles.
Seriously and unfortunately, health care will continue to deteriorate in the USA. The problems are far beyond changes in polices, laws and so on. Do you feel that you are a physician in the true definition, or the fact that we are "health care providers"? Do you feel that you are truly practicing Medicine, or providing a service? Are our patients truly patients or customers? Do we have support for our decisions from our colleagues, employers and the system? Patients have the right to question their physicians opinion; especially, if it relates to significant decisions such as surgery, chemotherapy and so on. But in reality, the uneducated patients are questioning everything and demanding laboratory testing, special studies and medicine, which not medically indicated or necessary. Not only that, after such tests or medicine fails to satisfy their answers, they go to another hospital or physician to start all over again. This is nowhere more obvious than in the emergency room and the delays and crowding it creates. We are not free in every aspect of our lives. There are rules and laws most of us abide them. Most patients are free from any rules or restriction to demand whatever and whenever and wherever services they want. Our ability to know the true medical history of the patient, especially in the emergency room, is very limited. The patient could have been in the next hospital for a week and comes with the same complaints to go through another round of work up and admission. We lack the true pharmaceutical history of many of our patient. We could prescribe a medicine that they filled the same day from another physician or facility. The electronic medical records are creating another obstacle rather than solving a problem. We have the technology to make significant leaps in creating reliable electronic medical records, portable and accessible to practitioners everywhere. We will continue to be tied down and held back by multilayer of obstacles from patients and society, systems and regulations, rules and laws, and not least by our colleagues who betray all of us by their opinions that were bought by lawyers. The joke of HMO is so painful; it is hard even to talk about. They are simply thieves among the many thieves that spread in our society under the "Free Market" umbrella.
Over the past nine years I have been trying to make people laugh with my publications (Placebo Journal and Placebo Gazette). The stories and parodies illustrate much of the absurdity in our healthcare system. Right now healthcare reform is all the rage and I fear that when it is all said and done (after the politicians make their backroom deals with the special interest groups) that patients will be left out of that final conversation. Please help me to remind the politicians not to leave the patients behind! We have created a song and accompanying video that illustrates this concern. It is not one of our humorous pieces. This one is serious. This song and video are NEITHER LIBERAL NOR CONSERVATIVE! There is no personal agenda here. You can download the song by going to the home page of our website www.placebojournal.com. Look for image with the patient facing Capitol Hill and follow the simple directions or...
If you want to directly download the song from this post:
www.placebojournal....
The lyrics are here:
www.placebojournal.... You can also see the video at multiple locations:
YouTube
BlipTv
Metacafe
It is important to remember that we are all patients (I have had 6 knee surgeries, Grave's Disease, and malignant melanoma). Let's show the world we have a voice.
Sincerely,
Douglas Farrago MD
Editor and Founder
Placebo Journal
Given our busy work schedules and narrow education its easy to forget the history of medicine. With reimbursement at an all time low for prenatal care, and liability premiums at an all time high for obstetricians, we are looking at a return of the Dark Ages as more and more obstetricians leave the field. Is the American public ready to return to maternal death rates of 50%? How many of us have read a historical account of times prior to modern medicine and noted the dispassionate line about a mother who had 'died while giving birth'? That was an accepted part of life when there weren't adequate personell to take care of laboring patients with complications. Currently obstetricians are being put in a situation where we stay awake for hours at a time and get paid peanuts. Anyone would be crazy to STAY in a field like this, and anyone would be crazy to GO INTO a field like this. When I teach medical students, how can I honestly encourage them to enter into OB/GYN? The profession will die, and unless something is done, new mothers may die along with it.
I've signed but I'd suggest Congress scrap all their Bills and, instead, draft a TORT REFORM bill, save our OB's, and save $30 Billion in malpractice costs.
Obama Health Czar: Any Czar appointment by Obama effectively bypasses Congress or any other oversight and leaves decision-making and operational decisions in the hands of Barack Obama through 'Executive Orders', which is the primary reason for Czar appointments. There is 'Nothing New' under the Sun and this approach was used about 70 years ago in Germany. This approach is basically a 'Hierarchical' structure where someone is appointed directly and has the sole responsibility of oversight of a particular function i.e. 'Detroit Czar', with little interaction with anyone other than Barack Obama.
Torts, Insurance and HSA's: We need urgent Tort Reform. Investigate the Trial Lawyers PAC Lobby and how much they pay Congress to support them. Indict the crooks and remove Sen. Specter (PA) in 2010, the worst of the bunch. Indict the corrupt politicians surrounding B.O.!
Have the Justice Dept. investigate the largest Health Insurance Cos., remove their ANTI-TRUST EXEMPTION, and break them up like AT&T. Many smaller cos. can compete effectively in a free market and work with us fairly. Allow insurance policies to be sold interstate to provide more competitive pricing and better negotiations with us.
The HSA is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all team members who work 30 hours or more per week (about 89% of all team members) for a high-deductible health-insurance plan. They also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness. Their employees love the Plan! Even Obama, Pelosi, Reid, et al, could have an HSA! Let insurance companies sell health-care policies across state lines.
Interstate Insurance: This excellent idea has been before Congress since at least 2005, when Rep. John Shadegg of Arizona proposed it. Why not remove the restriction which now says that if I live in Washington, D.C. I've got to buy a D.C. health plan. Instead create a national market for health insurance, so if there's a cheaper plan in Pennsylvania, you could buy it in Pennsylvania?"
Interstate competition made the U.S. one of the world's most efficient, consumer driven markets. But health insurance is a glaring exception, esp. since it has an ANTI-TRUST EXEMPTION. When the competition caucus in Team Obama has to look for Plan B, this is it.
Stop Obama's plan to create a Universal Global Reimbursement Plan for Private Insurance! This is just a modified Public Option Plan to blame Insurance Co's and suck us into another B.O. Plan!
No one listens to the Dr,. He makes too much money. wait until they cannot get care any more. Thank god I am a Dr. and can prescribe meds for my family...God help the goverment to understand,
I signed the petition (with my real name; I have nothing to hide here), but I would support any legislation which would rein in the insurers; ideally they would lose their for-profit status, their right to refuse coverage, their right to engage in 'recission' (an especially heinous practise in which they drop coverage to people retroactively after they have been diagnosed; I think there should be a special circle in hell for those who perform and countenance such a practise), and be forced to code and bill the same way regardless of what company they are.
You know, there are other countries where physicians don't even need to hire anone to do the billing; they just fill out a simple form electronically just as they do an H&P or a progress note, hit send, and promptly get the reimbursement.
And, since I was led to this site by a 'tell us your insurance company horror story' teaser, let me just say this magic moment in my life: Getting on the phone and arguing with some insurance company dweeb about coverage for my patient, injured in an auto accident, to prove that this was not a 'pre-existing condition'. Somehow I think many of my colleagues have similar stories
Agree all the way. Perhaps President Obama should ask his fellow lawyers in France and Canada about their legal systems. If he is so hot to copy their medical care systems he might consider some serious tort reform to more closely approximate their legal systems, too. I personally don't care if they don't pay me one more cent to be a family doc just get the stinking insurance company drones off my buttocks and let me do my job instead of playing word games with a bunch of deadbeats.
Here it is: I am 61 years old, lived in the US for nearly 3 decades worked all that time and currently do not generate adequate income at the office, to pay for my own health insurance. I do not expect much change in this situation as long as access to health care is considered a "consumer product" rather than an entitlement, associated with residency, as is the case in modern world. The same applies to, reportedly, 20 % illiteracy rate among graduates from high scholls in my state and few other social issues. It is not a matter of "reform", I believe. It is a matter of progress, as opposed to going backwards. Holding on to 19-th century standards is not going to take us far.
I am a physician / Harvard MBA who has practiced family/urgent care medicine for 20 years while also having a career as a serial health care entrepreneur. The doctor-patient relationship has declined dramatically over the years - recently at an exponential level. The threat of malpractice law suits, the decline in reimbursements, and the ever-increasing power of health insurance companies to call the shots (and call us "providers" and not doctors or physicians) have all contributed to this. Very few of my primary care colleagues will follow a patient into the hospital - for good reason -- it is a lot of work without many thanks or much reimbursement (thus the rise of hospitalists). Where it used to be embarrassing to refer a patient to the ER (especially during the day), it is now routine to send a patient to the ER for a problem that is too much trouble, takes too much time, or too malpractice risky to deal with. And we no longer get paid enough to worry; so, when in even slight doubt, we get the CT or MRI.
A situation that I ran into two years ago at a Florida hospital while working on a telemedicine venture tells it all. The company that I was working with provided telestroke services for hospitals that did not have neurologists available to treat acute ischemic stroke with TPA (stroke outcomes are often much improved if the stroke patient is treated with TPA within 3 hours of the stroke). The problem -TPA can be a risky treatment, as it can cause bleeding and death in a small percentage of patients. We provided (I am no longer involved with the company) stroke specialists to give this treatment to qualified stroke victims via telemedicine. Of note, this hospital had 11 neurologists in a group practice right across the street. Because the treatment is malpractice risky and the reimbursement rate is so low for the time involved (a neurologist would have to leave his/her office for 2-3 hours to treat a stroke victim with TPA and for this receive less than $200 in reimbursement - a neurologist could easily generate $1200 during that time in the office), the 11-neurologist group refused to do ER or stroke coverage. The neurologist would lose money and could get sued for millions of dollars -- who would want to do that??!! I never thought I would see the day when physicians would be so disgusted with the health care system that they would turn their backs on patients in distress, but I can't really blame them.
Medical services are already rationed by the 'insurance' companies who are understandably more interested in profits and executive compensation than the sick. Patients come into the office stating they have 'full insurance'. They discover only then all the exceptions and limitations. This is especially true in psychiatry which has limited coverage thanks to the influence of HMOs and PPOs and the social disapproval. Medicare also gives the impression that it is full insurance. It has too many exceptions, such as optical. It also has a fee schedule that barely meets overhead in metropolitan areas. Ted Kennedy blamed hospitals and doctors fees for the cost of medical care. He never looked at the for profit insurers, or the pharmaceutical 'industry', or the corn producers that encourage fattening foods and are SUBSIDIZED to produce more, etc... Even with the government option, costs will be a problem since there will have to be a LARGE number of new doctors, and their incomes, and additional facilities as well as... Then there is the question of adequate funding to avoid the debacle of Canada, or the problems of the UK. Medicare is a good example of inadequate funding. Politicians are notoriously unsympathetic to incomes other than their own, especially when they can blame others. A national health service can solve many problems, but inevitably will generate its own. They are likely to be less of a problem for the citizens\people than what we currently have.
Dr. Alfred Bonati, who heads the American Society of Medical Doctors, says he plans to say "no" to accepting patients under a government run plan and, according to a poll he cites, so do an awful lot of other physicians:
Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.
Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient's family.
Any health care reform must include improved reimbursement for primary care physicians. Preventive medicine will ultimately result in great savings in health care costs and primary care physicians are at the forefront. Unless there is improvement in compensation fewer medical school graduates will opt to persue a career in primary care medicine. One major issue is the absurdly low reimburement for vaccines. Some insurance companies actually wish to pay physicians at cost for their purchase of vaccines and then pay a ridiculously low amount for vaccine administration the same irrespective fo the cost of the vaccine which can vary from about $15 per dose to $120 per dose. This gives primary care physicians little reason to be involved with vaccine purchase. Having vaccines supplied by the state or federal government in a vaccine for children program would be far preferable.
(This is an email I sent to Dr. Rohack, the President of the AMA. I agree, without some form of malpractice reform, it is not real reform. Recently, Howard Dean said they are leaving liability reform "off the table" because they don't want to upset the trial lawyers.)
Dr. Rohack, I am reading your article in American Medical News and all I can think is that while sitting at the table with all of the politicians, YOU have become just like them. In your article you include a few words that make doctors think you are on their side, "including pushing for liability reform", but most of your words sound exactly like the politicians. I am sure that the membership in the AMA is suffering as a consequence of your position in the current healthcare debate, and appropriately so. I am a cardiologist, like yourself, and practice in Miami, FL. As you probably know, we have the highest malpractice rates in the country. No one dies in Miami-Dade county without a lawyer being called. We also have one of the highest cost/medicare patient. The reason is clear to anyone practicing here, defensive medicine. Sometimes the degree of defensive medicine we see is shocking. Like a patient who I saw in the office a few weeks ago who was seeing me because surgery to fix her BROKEN ARM was delayed by over a month as people were concerned about the risk of the operation. This was a fairly healthy 60'ish woman, who obviously did fine. It is hard to believe what medicine has turned into in our area. But I can assure you that no one in this chain was delaying her to make extra money, it is just plain fear (of lawsuits)!
My point here is that your balanced article is not really representing doctors in Miami-Dade county. If you were representing us, you would be at the table saying if liability reform is not being discussed, we will not sit at the table, period!! The debate that you are having with these politicians is intellectually dishonest. You are telling the American people that you are trying to put together the best plan for them. The truth is that they have essentially taken liability reform off the table, but you continue sitting there telling yourself that you are helping by debating the other important issues. For doctors in Miami-Dade county, and for many across the country that is a joke! The fact that the President used you as a pawn, by telling the American people that doctors were behind HR 3200 because you were "at the table", makes YOU (the AMA) a joke. Dean Heller, MD
I am an Internal Medicine Resident and I am part of the problem. I receive patients transfered from other hospitals who have already done expensive workups including labs, CT scan, ultrasounds, and caths, though we have to often immediately repeat many of these due to poor record transfer and urgent need for diagnosis. Often they come through our ED as an extra ED visit. All these have already been billed to the insurance provider once and will likely not be paid for twice, so I drive the cost of healthcare up, and my hospital's reimbursement down, and I have no way to fix it. My hospital has to pass the expendature on to another by inflating costs just to stay open. We all do this, not to make money, but to take care of patients and keep the doors open. I drive up costs, would like not to, but I take care of patients.
I am a physician with the long white coat, long hours and loads of face time with patients and families in critical parts of their lives, though I make 40k a year and carry three times that in debt I put off as long as I can. I have 2 young children who have no idea why I am I am never home and dont understand that I have to moonlight just to pay my bills and keep food on the table. Dispite this, I am still a "physician" who needs a paycut to pay for a broken healthcare system. Unfortunately physicians have yearly taken paycuts and cuts in reimbursement dispite yearly increases, or COLA, in every other field, from lawyer to laborer. By the time I actually apply for a job I will have 7 years of education after my college education and if I went into business or law I would be sitting on a board, or be partner, either way clearing high six to low seven figures without question, but my future salary is now in jeopardy.
We have redundancy in our system which add costs and is hindered by poor information systems. Our tertiary care hospitals absorb the costs of these and those unable to pay and have to raise costs just to stay open. Our basic costs are driven up by factors that if fixed could reduce healthcare costs more than any provider pay cut.
Much like any market driven industry, healthcare providers need security if we are to continue to complete 3 to often times 10 years post undergraduate education at 40k a year just to care for other people in our community. If lawmakers would like to make it less an incentive for the smartest in our culture to persue healthcare, I would urge you to think about who you would like to operate on the brain of your 3 year old if he develops an unexpected cancer, or to be threading a wire and ballon into the heart of your parent as they enter cardiac arrest with 2 minutes to survive.
I am a cost to the heathcare system, I would love to minimize it by fixing broken systems, but I will not Sermo Doc 55 the care of my patient and your loved one and I hope that I am not sacrified in the process.
1. What exactly are "middleman" insurance companies doing that warrant them taking up to 15% of your healthcare dollars? That'd be NOTHING!....REGULATE THEIR PROFITS....(oh...that'd mean reforming Government...eliminating lobbyists and special interests...and then our "Representatives" could only get an occasional lunch instead of pens and sticky notes! (gasp!)...OH...THE HUMANITY!)
2. When did my services as a Physician become the intellectual property of the U.S. Government? What if they gave a "plan" and no Doctors came!
3. Why did I have to trade both of my own kidney's for an MRI for a patient last week?...having to explain Sudden Sensorineural Hearing Loss to an Insurance Company "goon" who, never having heard of the condition, had the ability to deny the study to the patient? NO ANSWER?
4. Why doesn't the President of the United States know that in NJ, you are likely to get more $$$ by seeing a child twice in the office, than by taking out his/her tonsils? UNINFORMED! $202.50 for some of these big ticket cases...no risk/no down side, right?
5. Can someone tell the Congress and the public that the Brinks Truck doesn't stop at my office anymore!
6. Confession of the week: A patient ratted on another patient this week ... (is that a HIPAA violation?)...told me her friend was having ear problems and had been laid off...and was skittish about calling the office due to her lack of funds...I had the staff call her and bring her in THAT DAY...charged her $0.00....she said "THANK YOU!"...that was more than adequate payment...don't hear it enough since we all became "public enemies". If the media wants to know why a professional would do such a thing?...the answer is "Because I can!".
7. There seems to be a problem with various Insurers receiving requests for studies, despite our sending or faxing them to the correct place. I propose that all communications be sent to the same address that patients send their premiums...they never, ever, don't arrive at that address.
8. If I had time to figure out which Insurance carrier prefers which medication, I'd also have time to travel to Mars and back this week. Here's how it should work: I write the script for the med I prefer...the pharmacy dickers with the insurer as to the appropriate or "recommended" substitution...not my problem...nor should it be my problem if there are complications due to their mandated substitution.
9. I practiced 25 years with narry an error related to my written prescriptions. I'm using the newly mandated E-Rx system for 6 months now...3 errors so far...and one week of constant callbacks due to non-received Rx's. Come clean...this is not meant to reduce errors...it's to track and eventually ration Rx meds.
10. Wanna save money?....Cut waste and abuse. My Dad, may he rest in peace, had enough diabetic supplies for the entire state of New Jersey!...and received them for months after he passed. They called regularly and "coaxed" him into "needing" more, and more, and more! (Our greatest generation does have trouble turning down free stuff!...It's "unAmerican!") Who's watching the durable medical goods henhouse?
Need I continue?....Tort reform, fair reimbursement, buried in paper (soon to buried in paperless paper), I forgot my referral, and do you really collect those copays? (you cheap and heartless bastard!).
I obtained an MD and a PhD from one of the more prestigious medical schools in the country. I completed two years of general surgical residency, and decided to change fields to anesthesiology.
I was not able to find an open residency position in anesthesia, so I'm currently taking a year off...I obtained a medical license with no problem, but have been completely unable to find employment as a moonlighter or even a general practitioner, or in fact any employment other than part-time work for a "pain center" in Philadelphia.
Even though I'm not technically working as a general practitioner, I have been unable to find malpractice insurance (claims-made policy) for less than $25,000 for two years of coverage as a part-time GP, tail included. I therefore will have to work either as a waitress or perhaps in a grocery store like Trader Joe's in order to pay my malpractice premiums, not to mention my own health insurance costs ($95/month for what is basically catastrophic coverage only).
I've applied for numerous research coordinator positions, but because I'm overqualified, I have not been hired. I don't care about making a good living; I just want to be able to pay my bills without running a deficit at the end of the month.
I recognize, of course, that many other physicians have it much worse than I do, not to mention the millions of uninsured patients who do not seek medical attention until they are literally dying - but at the same time, I never thought that I would have a problem paying my bills during a year off during residency. Without meaningful tort reform, there is no way to really reform the health care system in this country.
While the president and the democrats have made public there opposition to tort reform, I have yet to hear their explanation for their positions. While most of us assume the obvious reasons, I find it interesting that they have not been pressed on this issue. How can the president expect doctors to give and give if he is not willing to meet us half way. Maybe if he gave a little on this issue, we'd be willing to work with him on some of his other priorities.
Open letter sent to my elected officials from Hawaii:
Dear Sir,
The Health Insurance Reform bills working their way through the Senate and the House need to be stopped. As a physician and parent, I fear for my ability to continue in the practice of medicine under the oppressive and intrusive legislation working its way through Congress. No matter what name you call it, this will become Socialized medicine with control of health care decisions removed from the doctor-patient relationship and placed into the hands of a bureaucratic panel with a mandate to cut costs not save lives. As a parent, I fear for my children and the mountainous debt they are being saddled with by Congress and the President (before the one to two trillion of Health Care Reform costs). How can you go along with this reckless spending of money we do not have? How can you consent to the policy of printing trillions of new debt to fund Stimulus, Omnibus and the President's budget? FDR proved that spending does not get you out of economic crisis: why do we not take lessons from history.
As a 53-year-old cardiovascular anesthesiologist practicing in Honolulu, I sometimes work 80-120 hours a week, day and night, to the point of exhaustion. I am a vanishing species; no other physicians (anesthesiologists) are willing to subject themselves to the rigors and demands of cardiovascular anesthesiology. There are fewer than twenty-five (25) of us left on Oahu. The Health Care Reform bills as being considered would drive more of us (CV anesthesiologists) to other states with better reimbursement and more physicians willing to subject themselves to the work.
I beg you to reconsider your support for the President's radical policies and consider the long-term consequences of continuing to spend money we do not have thus, the taxes that will be necessary to pay for this spending. I ask you to oppose the concept of Health Care reform that moves us to a Socialist form of Health Care: think of the failures of Keki Care, Massachusetts Health Care, the Indian Health Services, Canada the UK. 85% of Americans are happy with their health care. Please do not destroy the whole system to try to cover the uninsured.
Respectfully, some health care suggestions:
First, fix (the under funded) Medicare and Medicaid programs.
Second, allow health insurance companies to compete with each other across state lines.
Third, expand the number of physicians before you try to cover 40-50 million new patients.
Fourth, provide for adequate reimbursement for physicians so that the brightest and best continue to want to go to medical school.
Sir, please reverse the reckless spending and printing of money stealing prosperity from our children.
Thank you for your time and please fight against the destruction of our health care system because no physician will work as hard as I do now under a Socialist system.
I am trained in Family Medicine but left to start a consulting practice helping people navigate the medical system. I have been struck by the fractured relationship between doctors and patients and I believe that this is a crucial area that needs to be addressed head on. Blog posts from disenchanted physicians lead to vitriolic comments by furious patients. Everyone seems to have forgotten that we are on the same side. How did we, doctors and patients, become enemies? We need to commit some energy to healing this broken relationship.
IT'S WORSE THAN YOU'VE BEEN TOLD! In North Carolina the full roll-out of the RACs (Recovery Audit Contractors, for Medicare) has been pushed back til next year so the screams of those who have already been through the arbitrary Prepayment Review process will not resonate in this debate. Ask your Prepayment Review consultants - spending more than 24 minutes with your patient will almost always be arbitrarily downcoded by a distant "nurse, or less-qualified person", no matter how old the patient, no matter how many critical conditions on their problem list, no matter if mental illness is one of their co-morbid conditions. If you can survive 5 levels of Prepayment Review appeals under stringent time deadlines, before getting a chance to sue in Federal court, you may have some late vindication but probably not with a still viable medical practice. Those I know who are enduring this process are generally getting less than a fourth of what Dr. Harris gets for the same services!
TOP MEDICARE LAWYERS OF NATIONAL PROMINENCE will tell you that physicians have almost no true rights of redress under this system, and will be forced to spend less time with their patients. The AdvanceMed Corporation is conducting these Prepayment Reviews in North Carolina, and apparently will continue to do so, despite being the subject of a scathing draft OIG report last year as noted in a front page article of the New York Times, 8/21/08: "Report Rejects Medicare's Boast..." wherein it was reported that "Senator Grassley said Congress might push for an investigation into the private company that was hired to fulfill Medicare's auditing program, the AdvanceMed Corporation", that still rakes in many millions of dollars a year despite Pete Stark's quoted opinion that "this agency is incompetent", and as the article notes, they don't hesitate to "cook the books" in order to "to look better to the public".
Read about Dr. Smith's woeful experience in Family Practice News of 7/15/08, where the AdvanceMed Corporation was noted to be off in their reckoning of the Medicare portion of her practice by nearly 2,000 of the 2935 patients that they would have preferred to unscientifically extrapolate their results to include, and the "guilty until proven innocent" mentality that she endured. Her testimony before the House Committee on Small Business, chaired by Rep. Charles Gonzalez (D-Texas), did not change the incentives built into the RAC system to reap windfall incentives by determining that "medical necessity" was not met, in the absence of any medical director to review or substantiate these findings until the program is made permanent in 2010.
"Dr. William A. Dolan, a member of the American Medical Association board of trustees, also testified before the committee: 'The best way to reduce common billing and coding mistakes is through targeted education and outreach, rather than onerous audits performed by outside contractors provided with incentives to deny claims,' he wrote in his testimony. One of the greatest problems is RAC's ability to designate improper payments based on contractors' judgment of 'medical necessity....We do not think that these reviews are appropriate for the RAC program and believe that they exceed the authority imparted to the RAC by Congress. These reviews should be conducted by clinicians with relevant experience and expertise,' testified Dr. Michael Schweitz," notes Family Practice News.
Another physician in Florida went into such debt enduring a similar Prepayment Review with a heavy load of Medicare patients in her practice that before the year was out she and her family were literally homeless, and on the streets.
HOW MANY new patients do you want to accept into your practice next year under these conditions of RAC audit? HOW MANY of your current Medicare patients can you continue to serve when you can be subject to Pre and Post Payment Review for the current pittance Primary Care physicians are receiving to keep saving the Medicare program millions of dollars a year? HOW MANY of your pleas to Congressmen and Congresswomen will be answered with the due diligence that these physicians have so far been denied? HOW MANY Congressmen have even read the new legislation they are proposing, or the old legislation that is responsible for the travesties described above?
IT'S YOUR CALL NOW...Feel free to post these comments wherever they need to be heard.
I've read many postings of the general population's (non-physician) comments about Dr. Harris' editorial- that has been popularized on CNN....and it just shows that politicians and laypeople are absolutely clueless about what physicians do, how we manage patients, and how to lower healthcare costs. I am alarmed that physicians are being left out of the Healthcare Reform Debate. My response to those who think Dr. Harris' post is asking for pity and more money is this: if anyone reads Dr. Harris' comments as him looking for pity, they should re-read. His editorial is a testimony on how to lower health care costs. As he pointed out, we have a 70,000 Primary Care Physician shortage and 1/3 of those Doctors say they will retire in ~5 yrs= looming crisis. Pay Family Doctors more to retain them in the profession, pay them for what they don't have time to do now b/c they have to do it for free (preventive medicine), attract quality/intelligent people into Family Medicine thereby increasing the numbers of Family Medicine Doctors(and other primary care), who in turn work their tails off by keeping people healthy and keeping them out of Urgent Care (more expensive), and ERs (even more expensive), and the hospitals (the ultimate in expensive). Also, these measures will keep MORE PEOPLE HEALTHY and AT WORK / Less Costs to Company/ improve productivity. Supply and Demand & Free Market DO work in healthcare. We've just let insurance companies be an unnecessary middleman.
The reform being discussed by the Obama Administration absolutely will NOT work in our individualistic society (that is if you want to maintain the quality of care we have now). Americans do not want to change their lifestyles. Until then, healthcare will not work. Obama's interest in psychoeconomics: the psychology behind individual decisions(and decisions usually not in the best interest of that individual) and how it impacts the economy (in this case: healthcare), should lead him to the same conclusions. That doesn't seem to be the case. You have to incentivize individuals to stay healthy...and also probably penalize the unhealthy lifestyles. We do this in any other form of insurance, yet it is 'prejudicial' in healthcare.
We had Cash for Clunkers, a widely popular program willing to shell out Billions to individuals to purchase barely more environmentally friendly (healthy) vehicles....all in an effort to make some of us more green, and to boost an industry that has kept us dependent on foreign oil and slowed our progression to a more green economy. Imagine if we did this for healthcare. Pay people to be healthy, maintain health, and prevent the decline in their health. What a concept. 'Cash for Junk in the Trunk' is what I'd call it. Imagine if we paid 1000 dollars for every ten pounds people could lose. I would have patients lining up in my office trying to lose weight! And....many of them would shed alot of pounds...thereby lowering their blood sugar, blood pressure, reducing their risks of heart disease, cancer, dementia, arthritis, etc, etc, etc. They would exercise, change their diet, and our economic savings would be astronomical in healthcare cost recution and increased job productivity. Study after study after study show the savings in healthcare expenditures with reduction of weight, blood pressure, blood sugar, etc. Many studies repeatedly demonstrate that almost 85% of healthcare costs are due to lifestyle choices. How does lowering reimbursement, paying physicians less, and 'expanding' healthcare or making it free (or taxing the rich to fund all this) address or incentivize individuals to change their lifestyles? I have yet to hear the politicians, Obama, CNN, or anyone else address any of this. I've heard alot about pay-for-performance and I've sadly seen this slowly leaking into how physicians are paid.-An insane tactic to not pay physicians when their patient's medical problems are not controlled. How is this the physician's fault? I don't get this concept. All that will do is lead to is noncompliant patients NOT being able to find a physician to take care of them/ patients being fired from practices left and right.
I support the Dr. Vance Harris post. I support Sermo and all the physicians speaking out on healthcare reform. I support the Physician's Appeal and signed it with my name, and I support 'Cash for Junk In The Trunk'....the biggest bang for the buck in reducing healthcare costs.
The other evening I went the town hall meeting scheduled for 7PM in Reston, Virginia at which Congressman Frank Wolfe was present. I arrived about 7:10, to find that there was no parking within nearly a mile of the meeting site, with cars parked along just about every road in the surrounding area, many from Maryland. I never got to the building, but most people I saw were carrying posters clearly skeptical of the health care proposals being promoted by our federal government.
I am a clinical neuroSermo Doc 102, in active practice, and graduated from medical school in 1968. I have practiced in the military, in an academic setting, and in private practice, and by this time have seen about everything. I have also watched the inexorable deterioration in the physicians ability to care for his patient over the years. In the early 1970's I heard the phrase over and over again "healthcare is too important to be left to the doctors." Well, we now have in the hands of politicians, lawyers, and business administrators, and I don't think we're any better off. In fact, every time any one of these entities meddles further, things get worse, and today healthcare is probably the most restrictive industry we have, and patients have not benefited from this. So, I am happy to see this amount of public involvement.
It certainly is time for a change, but not the change envisioned by our legislators. Had I made it to the meeting, one of the things I would have asked about is the proposed "single-payer program," I believe a disingenuous proposal. The fact is medicine has always been a single-payer program, and that payer is you, dear reader, the patient (read "taxpayer," if you wish). What is really happening is that there is now a great debate going on as to who gets to be the intermediary, the entity that controls the flow of money between the recipient and payer (you) and the provider (me, or a hospital or other such facility). Up to this time the intermediary has evolved into either the government or an insurance company or similar entity. The government, especially the government we seem to have voted into power this cycle, seems the more ominous of the two, because in assuming this power the government is edging toward defining life itself, which it clearly is already in the process of attempting. Personally, I think this is dangerous, but that in no way exonerates insurance companies or other such entities. As the alternative intermediary, the insurer is simply the lesser of two evils, and that includes all kinds of insurance, even malpractice insurance, also known to us as "the lawyer magnet," a closely related issue receiving scant attention in the most prominent proposals.
But the real question to the American public is and should be "why do we need an intermediary at all?" We were doing quite well before the introduction of third-party payers. And, we have always had charitable institutions, as we still do, to take care of those who could not afford to pay. The word "charity," however, is unpalatable to some, and so we use the word "entitlement," engendering a remedial program, and of course once again we have burgeoning intermediaries to administer such programs.
I hope we as citizens have come to recognize finally that all of these intermediaries are siphoning off too much of the money and more importantly at a deeper level, too much of the power. It is time to ask, critically, if they were ever needed in the first place. The introduction of third parties into medicine was not the answer. Now, it is the problem.
I think Sermo is getting out the word that doctors are the key to controlling health care costs--but, the media is quick to demonize our profession, and scapegoat physicians
as the core cause for health care implosion. Frankly, the AMA has been selling us out for years, and with a liberal controlled Senate and House, we are SURE to get the short end of the stick, and soon. Be prepared to organize into groups, and drop health care plans and insurances for fee-for-service; or, accept patients who's time to treat does not cover the cost of your overhead expenses. Is anyone else tired of working 50% more hours than they did 18 years ago, and being reimbursed now only 50% of what we were reimbursed then? Maybe there's more nobility than I thought in being a plumber---at least some people appreciate their services more than mine. You see, that's because health care is now a RIGHT, and doctors are no longer doctors, but health care providers.
We just tried to change from our current EMR to one that is CCHIT certified and it's a nightmare of additional documentation, extra steps, and very cumbersome to providers. Primary care doctors are already dropping like flies because of the ever increasing demands on us that benefit people OUTSIDE our exam room, like insurance companies, stock holders, lawyers, etc. We need real reform, increased number of primary care doctors and increased reimbursement for the myriad of tasks all those involved want primary care docs to do, but currently are done for "free". We can't go on with such a small margin of profit and declining patient and doctor satisfaction.
Let Your Voice Be Heard and Stand United With Fellow Doctors. Please make every effort to attend: "WHITECOATS ON CONGRESS", Thursday, September 10th, 2009 at Upper Senate Park, Washington, DC. We are expecting 10,000+ MDs from across the nation. For more details go to: www.docs4patientcare.org. This is the defining moment of our profession. Get involved and stand with us in proposing realistic, practical and affordable solutions rather than a massive government takeover of American healthcare. Go to www.docs4patientcare.org ASAP. Time is running out.
Agree with Migraine Maven. Unless we regain control of our patient management, the game is over. If large employers were smart, they'd hire their own PC Physicians as the Rosen Management does in Orlando. The company has its own docs, clinic, pharmacy and the employee co-pay is only 5%. We have to start thinking innovation. As long as insurers control our profession, nothing will change. NOTHING.
I am an EM physician in NJ, working under a system that is stressed and overwhelmed. I am troubled most by the tragedy of limited access to the system at any point other than the ED. It is all too common for patients to present to the ED with minor or chronic complaints simply because they have no other means to seek medical treatment. We are failing these patients miserably. We need more access to primary care, fewer/less expensive tests and treatment, and greater protection from liability so we can continue to serve the vital role as great health care providers. I am committed to providing the best care to all I see, 24/7/365, but the system must do the same.
My only problem is the anonymous posting of support. If you beleive in it ,don't be timid about putting your stamp on it. The biggest threat to health care is going to be availability of competent people to provide the care. The prospect of being a doctor going forward is a cause for serious concern but at least there is an element of choice and a profession can be changed. In regard to the reality of being a patient, that really scares the hell out of me.
One of the major problems in our current systen is the working population who make too much to qualify for state aid (AHCSS in Az) but don't make enough to afford private insurance. Also there appears to be an increasing number of patients who have lost their jobs and their insurance. I recently had a 42yo male with a large cancer of the tonsil. He had a job and insurance for 17yrs but lost his job(and insurance) a few months ago. He has since developed a large tonsil cancer for which he needs chemo and radiation. He and his family now have to pay out of pocket for his treatment. I believe with our current economy this is becoming more common. This has to be fixed. We take care of many patients in similar situations at our institution (Maricopa Medical Center) where patients are evaluated on a sliding scale, fee reduction program. The problem is that this adversely affects our bottom line, but we do it because it is the right thing to do! The system definitely needs to be fixed so the patients get the appropriate care they need and the doctors get paid fairly.
The current system is an augean unsustainable mess for multiple reasons directly related to federal legislation and oversight:
Insurance companies exclusions from anti-trust Medicare and unrealistic reimbursement formulas EMTALA federal laws mandating unfunded care via ERs HCQIA federal laws providing legal immunity FDA bureaucracy in the development of new medical devices and drugs
The problems we are seeing with inefficiency,costs, non-competitiveness, and poor quality inaccessible care all stem directly from the above federal laws and regulations.
Medicare trust was a gold mine until people lived longer, costly medical advances, and lack of political will to increase assesments ultimately threatent to bankrupt the federal government goose that laid the golden egg.
These same wizards, slept while Fannie and Freddie Mae danced to the the tune of Nero Wall street's fiddle.
Now we have to get serious with 1/6 of the american economy. Bernake said it best when he defended the independence of the Fed. Congress cannot be allowed to interfere with the Federal Reserve lest the cancer of politics metastasize to important parts of the machinery of the economy.
One has to wonder why people are so vehmently critical of a government plan that involves additional meddling by novice politicians. The average american still believes in life, liberty and the pursuit of happiness. This pursuit is not possible without the security of high quality readily available health care.
By way of introduction (and risking sounding too stuck up-but bare with me, as I will come around to making this meaningful), I was trained in NYC at big-name schools/programs, have a degree in health management from Columbia and joined the USAF after 911. Requested and got an assignment in the midwest to be near my kids from a previous marriage and although military life was tough and not for me and my family, I am proud of having served and feel nostalgic about the things I got to do, the deployment, the awesome people I got to work with and take care of and the sense of gratitude for my years of service. We liked the area and the kids were in school so we stayed.
I had moonlighted in the area (hospital & outpatient) before getting out of the military and found it 'OK' to practice in -- lots of 'old-school' psychiatrists in the area, not too biologically oriented and with poor foundations in general medicine and neurology - but, since many of the patients were grateful for a fresh perspective (21st century outlook) I thought what the heck, and took on a job as medical director at a wellness center and added neuropsychiatry to the center. The services took off - but the reimbursement in private practice, the paperwork, the endless and dumbfounding interference with the direct care of my patients by bureaucratic processes, all self-serving the insurance companies' bottom lines are already wearing at me -- only one year after I started the position.
The patients are appreciative, but the economy being what it is, no one is accepting easily the facility's inability to continue with business as usual and for psychiatric and medical services, they are slowly going to full self pay and cash-only (the worse insurance co's went first starting this Sept 1st) with projections to eliminate all of them in the next 6-8 mos if the practice survives that long.
Stable patients being switched from meds because its cheaper and one med is touted to the patient as being equivalent to the other -- yet we have sound (non-pharma) data showing that the mere fact of switching meds in depressed patients, may ultimately lead to treatment resistant depression - and in treatment resistant depression, the more you switch the more treatment resistant they become (STAR-D data). Some other studies show that this might be true for many neuropsychiatric disease states and not just depression (which is a big, common, debilitating, chronic, relapsing, remitting illness that crosses all socio-economic groups and directly costs the world economy not just our own, millions of dollars a year, let alone indirect costs).
I treat a broad variety of patients (not too many of either end: worried well, chronically/severally mentally ill). The majority of people I treatare middle class, working/school-going families with insurance; but it is just these people who will not be able to afford my care. Many of them have co-morbid general medical illnesses or pre/post surgical neurobehavioral complications (because of my other subspecialty).
The very poor have (although many times inadequate for sure) socialized medicine coverage and are protected from the costs of care. The very rich, well, even in economically hard times, being rich means a certain flexibility to purchase those commodities you value (more on this later) as important.
We as a country have an incredible amount of noble-prize winning and nominated talent in all areas of expertise, and yet it is the politicians who will come up with a plan and 'help us' decide on this very important piece of our lives (personal and professional). We (the greatest most technologically advanced democracy the world has ever known) should easily be able to come up with a solution that is uniquely American, and yet can/should encompass all of the good ideas that have been put in place in comparable democracies (and a few that are not democracies -- like CUBA --) from around the world.
I remember seeing the very capable and articulate head-honcho from Mayo on Charlie Rose a few weeks back, describing in a very clear way what we should be striving for: VALUE in our health care system and in the day to day provision of care. As he described it, VALUE=QUALITY/COST.
I am not paid to think. I know I echo what many in our country (mostly primary care, but even Sermo Doc 102s and interventionists have been known to be great thinkers and I have even heard many of them 'complain' out loud of the same limitations).
The clinic where I work out of bills out an hour of my time (double board certified, and board eligible in something else-didn't get to take the board since was deployed to the war) $250.00 (not the cheapest fee schedule but in-line with national/regional averages for neuropsychiatric specialty-medicine care). Depending on the insurance co, they might get a check for 45-48% of that (that includes co-pays) -- and then get loaded with misc paperwork and calls and faxes and on and on to require dedicated/extra staff. How can they stay in business this way? How could I hang a shingle? I have ben asked to partner in the practice and we are negotiating the deal -- but I have my reservations for sure. Yes they could 'negotiate' a better rate - but lets be real, negotiations are one-sided, those who hold the cards make the rules and unless you are large (we can't unionize in the US as physicians) you are out. I am not sure why, maybe the economy, but I have not been able to find any near-by IPAs or anything else that might give a two or three-person shop the leverage needed to truly negotiate a contract. As it is, we have been told by a practice-management consulting group to forget about negotiating better fees in general and for psychiatry specifically.
The value of what I do has been demeaned - which gets me to the point -- a cover article on business week a few weeks ago said it best -- the insurance companies have already won the healthcare reform debate by having shifted the talk away from INSURANCE reform.
These changes to my patient's treatment, forced upon myself and my patients, with no regard for their care, has to do with the business of business---which is business and making a profit. Do not get me wrong - I am a capitalist. Son of immigrants to this great country, they and I have benefitted from a capitalistic democracy and I am a devoted entrepreneur and capitalist; the things that make this a great country are more than just its capitalism, and I acknowledge and embrace that. So do most people (patients and otherwise) that I know do the same -- how many of us do not embrace the knowledge of the benefits promised by a great socialistic program signed into law in 1965 (Hill-Burton act): Medicare.
We must continue along the vein of this kind of thinking -- that their is VALUE in taking care of the health of our elderly, our children, our sick, our workers, our students -- everybody! Don't get me wrong, I too (maybe even naively and ignorant of ALL of its faults) acknowledge the imperfection of the program -- not just as citizen witness and son of two elderly parents who were lucky enough and industrious enough to be able to afford 'extra' coverage in their old age and yet have struggled on limited incomes to purchase medicines and care when the bureaucratic red-tape of signing on/off/part-d etc was too much for them to navigate and they fell through the cracks for a whole year -- but I am witness also as a provider of care, seeing the same as I just described above with my parents, but in scenarios much more disheartening with patients who have not been as lucky/industrious/thrifty/forward-thinking to be able to afford extra coverage. As a capitalist and not a bleeding heart, I know that these individuals are skimping on care, meds and fu and will ultimately cost ME more time, effort and patience as a provider and more of the same as a taxpayer. They will be harder to treat, sicker by the time I see them and more resistant to care from medical and social perspectives. But on top of that I do care, if I didn't I would not be devoted to the practice of medicine as a vocation -- not a business. Should we be entrepreneurial --for sure and there are other things in a medical practice that you can be more business-creative and enjoy entrepreneurship and business ownership/management etc, from.
What I see is that, as a physician, a specialist, a psychiatrist - a provider of care that requires me to think---alot--about general medical concerns, med interactions, nutrition, psychosocial aspects of the patients life, psychological responses -- and then synthesis these into a coherent plan of action and care to the benefit of the patient (not stockholders) -- that this professional that I am and the 'thing I do' ......
that I AM NOT VALUED - my time has no value and my patients health, as a function of the level of training and expertise -- of thinking about their health and ways to navigate the improvement of their situation -- is not valued -- by whom? By the insurance co with whom I have no 'strict' in-the-loop relationship with other than a 'cost' to be managed and curtailed so that the bottom-line of the business is in the black. So that the company can be 'healthy' - not my patient or the practice that treats them and serves a community of patients/workers/taxpayers/retail purchases/students/future populace --- so that the stockholder's purse can be healthy ...certainly not mine, the practice or the 'balance' of credit that would be health in any of my patients.
It's time that local and state medical societies 1) poll their supposed 'members' and, frankly, all physicians in their jurisdiction about their positions regarding various aspects of potential medical system reform, and 2) stop espousing the A.M.A.'s party line and start standing up for the majority of docs who, by and large, DO NOT support most aspects of the Obamacare health care 'reform' push...many of these medical organizations are far too left-of-center in their leanings to give them any credence to speak on behalf of physicians at all. On the flip side, it's time that doctors practicing 'in the trenches' start speaking out more!! The fact that any (and there continue to be several) news organization continue to dare use the A.M.A.'s positions on health system reform as a justification that 'doctors support Obama' is reprehensible.
cont. Ironically the government has said the system is broken and we need to fix it but as usual the important question of how it was broken has never been asked. It is impossible to cure a disease (except by accident) without first understanding how the disease occurred in the first place. With all the mistakes and ramifications of current federal legislation/laws, it is clearly summarized by an Albert Einstein quote: "We can't solve problems by using the same kind of thinking we used when we created them"
"Federal legislation, laws, oversight and under sight got us into this mess and will not be able to lead us out."
Excerpt from my opening remarks to SIMPD Annual meeting May, 2009, San Diego
Now let us say to solve that financial problem each patient directly paid their primary care doctor $2 a day to be in his practice, or its equivalent in fees for service directly with no third party in the middle, rather like they used to. Let us say the doctor limited his practice to 600 patients. Well, each doctor would generate $438,000 a year. Some might charge more if they were very popular and excellent, some less, but assume $2 a day or $750 a year for the sake of argument. It's the cost of a cup of coffee a day.
If they earned nothing else and had a 50% overhead the doctor would earn a good living, nearly double what current hamster wheel primary care doctors do under third party domination. The doctor would not have to deal with the third party insurance industry very much at all. Possibly, like me, he might also earn 10 to 20% more on big expense items like long hospitalizations that insurance does and should pay for, or maybe he would opt out and not bother to bill insurance at all.
Half of our 900,000 doctors would need to be in primary care to do this. Every American could have a private, personal, secure, real medical home for around $2 a day without third parties snooping in their records. Students, senior doctors and some specialists would flock back to primary care, the original love they were driven from by third parties. The primary care shortage would vanish, perhaps almost overnight. The incentive to do procedures would be reversed. Instead we would be incentivized to form relationships with our patients and treat them as friends as did Russell Anderson. What a concept.
That is our goal. Presented this way who could object to it? Who could not afford it? Those few in need could be helped to join such a practice by charity or government with donations or the medical equivalent of food stamps. But we have to get the third parties out of the way of primary care and basic office practice. Help us get the message to America, Congress and the White House during this important national debate on health care. You at this meeting have much more power than you think. Exercise it.
To demonstrate how ridiculous what we are doing now in primary care really is, imagine what would happen if we insured hair cuts. We would all be issued "MediHair" cards paid for by our tax system. We would present those cards for a "free" haircut to the local barber of our choice. We would seek the best and go often, since it was a covered service under MediHair. But eventually, as we have seen in health care we would be allowed only a buzz cut once every two months by a barber's assistant. It would be functional and take just three minutes and we would all look like marines. Barbers supervising their assistants would be a sad lot indeed.
But many of us would not like how we looked. We would seek opted out barbers and pay directly for what we wanted and needed. Opted out barbers would become the respected and happy professionals and compete to do the best work. We would quickly recognize that hair care is not an insurable event.
Because, an insurable event is an expensive, infrequent, undesirable occurrence nobody wants or expects. In contrast primary care and much of what our consultants do in their offices are not insurable events. What most of us do all day long is expected, common, inexpensive and even desirable. When we insure such events, we destroy them. The past thirty years have certainly proven that. It is time to get back to basics and once more do primary care right, the direct way.
Thomas W. LaGrelius, MD, FAAFP
President, SIMPD www.simpd.org 877-448-6009
I signed the appeal and agree with much of what I read on the Sermo website. But we have to face the reality of the corrupt system of government lobbying that we are facing. The reason that lawyers, insurance, and pharmaceutical companies get their platform heard and voted for is because they paid for the politicians that are making the votes and decisions. The trial lawyers paid for this system which is why they are benefitting from it. Physicians have always been too principled or frugal to put up the money to get a fair shake in this system. If we want tort reform, insurance reform, and to prevent the American medical system from being shaped/destroyed by others it's time to start playing the game. A dose of reality is needed in this sea of promising principles and ideals.
I entered medical school with the idea that I could care for people, help them make educated choices in lifestyle and treatment that would improve their lives and minimize future healthcare costs. Enter the cold reality that the major expense in practicing medicine is malpractice premiums which make it impossible to make a living and practice good medicine. It is unsatisfying to realize that you have to see so many patients in a day just to break even and then have a mountain of paperwork to fill out... I took a break from this to raise my family and had a chance to re-evaluate the lifestyle I had chosen. I am hoping that the healthcare plan will include real relief from the burden that physicians face today. Otherwise, not only will I probably not return to practice, but others will also come to the same conclusion. Health care while being more financially accessible, will continue to elude our poor due to a shortage of doctors who are willing to practice under these circumstances.
Dear Mr President,
I am an Internist who takes care of patients with very complex time consuming problems . Over the past years I've seen my reimbursement go down as my overhead goes up. I have refused to increase my patient load since that would mean spending less time with each patient and thus providing poor care.My day is bogged down with unnecessary forms and paper work which also takes time away from patient care and increases my overhead.I work all day, am on call all night and weekends and I am paid less than Joe The Plumber.I love what I do and am privileged to be part of the lives of my patients but I can't afford to stay in practice and like many other Primary Care Providers I am fearful that I may not be able to continue to care for my patients.I have 6 children whom I would love to encourage to become physicians but am afraid that after twelve years of higher education and massive costs they will not be able to support a family.I have great faith in your judgement Mr President . i think a public option makes sense but we must be clear that providing insurance to all does not mean quality healthcare for all. Any plan must include resources to allow physicians to spend more quality time with patients . If i was paid at the level I was 15 years ago I would be able to expand, hire new physicians , dietitians,diabetic educators etc and provide better care for my local community but instead Insurance Companies along with Medicare continue to increase regulation ,decrease reimbursement and make it harder and harder for private rural local community physicians to practice. Sure I could move to the city and join a complex mayo clinic type program but then I would be abandoning care in an area where it is needed the most ! ACO's make tremendous sense but these are just another name for the Group Practices that physicians wanted to participate in over 15 years ago but were forced out because of The Stark Laws that are still in effect today. I also believe tort reform is important as well. There is without a doubt bad physicians practicing medicine and those who are guilty of negligence should be prosecuted , but the vast majority of medical legal lawsuits are frivolous and take away vast resources,time and money not to mention cause psychologic injury to well meaning caring professionals. There should be arbitration panels made up of physicians ,legal and scientific experts who review claims of malpractice and only allow those cases worthy of true malpractice concerns be allowed to proceed through to the justice system. This would save a tremendous amount of time, resources and money! I know that a physician complaining about making money is hard to sell to the public but you must realize that the basic problem with our healthcare system is that a secondary economy specifically Insurance companies and big Pharmacy have taken billions of dollars away from the primary providers of healthcare .Is there fraud ?,You bet there is; Is there bad doctors? Yes there are just like there are bad lawyers and politicians. But the vast majority of physicians spent half of their lives and families money and resources studying and preparing to do good for the wold and for the patients they care for . The majority of physicians will do the best thing for the patient if given the opportunity and resources. You must realize that decreasing reimbursement and increasing overhead , regulations and paperwork forces physicians in our present system to see more patients in less time to make ends meet. This leads to unnecessary tests since spending less time with the patient in taking a history or completing an exam leads to relying more on expensive tests for confirmation or ruling out a diagnosis. Doctors then become detached from their patients and no longer know the intricacies of their histories,stories and care needs. This is not something that can be replaced by a computer but rather from time spent with the patient. i believe as you do that quality care should be rewarded and that best practice guidelines should be met but with the present reimbursement system those guidelines may be difficult to meet for many physicians especially if you add 25 million more patients into the mix without increasing resources available to private practices which make up the workforce of healthcare around the country. I love what I do ! I love taking care of my patients but, I ,like the majority of my professional community, am tired and worn out from fighting day in and day out to survive a system where the only real advocate for the patient is the physician who is limited by what he or she is able to do. My decision to become a PCP was made after meeting with my friends father ,who was a GP. I sat in is office and watched in awe as he pointed to the hundreds of patients pictures on the wall each one touched by his care ,each with a life story all of which he knew in great detail. This is what is missing in our discussion.... Thank you
This may be a very dumb idea but I'm wondering two things:
Would it be useful for docs to conduct a few "Town Halls" or "Tea Parties"?
If so, are there any docs out there who are:
1.Good public speakers who can handle nasty people (not me, I'd run)?
2.Doctors who are very knowledgeable about our present medical system
and what health reform needs to be passed in Congress.
3.Doctors who can take any heat later generated by such meetings?
What would SermoTeam do to help if such meetings were held?
Who knows, we might end up with some more good doctors in Congress and fewer lawyers!
Sermo Doc 262, it was clear on the Conference Call with the White House August 25th that although they know the presidents statement about amputations was absurd and insulting, its OK because the cost to the -system- of an amputation is quite high when rehabilitation and prosthesis is included. No matter that the doc doesn't get any of that money, its clear we don't really try to save anyones leg because its easier and more financially lucrative just to cut it off. As the limb-salvage expert in my region performing in-situ femoral distal bypasses for a fraction of the stated costs, I'm disillusioned and depressed by this constant onslaught of attacks on the status and esteem of physicians by the President.
I can't believe that every doctor in the country isn't making plans right know to march on Washington D.C. Thursday October 1st, and I'm frustrated that Dan and the folks at medscape haven't embraced and promoted this event.
10 more observations and questions (add to yesterdays 10) to ponder as you marvel at the specter of healthcare reform: don't hesitate to laugh and cry simultaneously!
11. Will Government run Medicine be like other Civil Service positions?...Beaucoup benefits, 4 weeks vacation, 20 years and out! FULL PENSION! Sounding better already? No?
12. Patient's seen at the walk in clinic at the grocery store ALL have fluid behind one eardrum...and are all placed on Antibiotics and Antihistamines...even though none of them have pain, fever, or hearing loss. If it ain't broke, don't fix it! ... and patient's will likely not return with firearms if you say these words honestly and sincerely: "You're going to be fine, and you don't need any prescription medication for your COLD!!!!!" Is this what's coming when Doctors are no longer manning the front lines of patient care?
13. Way back in the '90's the HMO gang showed up with an offer you couldn't refuse...guaranteed patients, reasonable pay, and less paperwork. Everyone went for the bait! The noose tightened year by year. Turned out to be plenty of patients, lessening pay, and mountains of paperwork...Today's advice:DON'T TAKE THE BAIT.
14. If "Healthcare" is a guaranteed right under the Constitution of the United States, then people who can't see and/or hear properly should either be on disability, or should be provided correction for their sensory deficiency (glasses and/or hearing aids). After all, Medicare provides canes, walkers, and all other sorts of assistive devices...why not the most basic of fixes for these most debilitating of problems?
15. If BC/BS of NJ is a not-for-profit company, and they have billions in reserve...and they made zillions last year, why were they granted a rate increase this year?...must be that clean "Jersey Air".
16. There are more ED commercials on TV than commercials for beer and breakfast cereal combined! Why not have people call 911 in case of an erection lasting for more than 4 hours? Then, they'd abolish these commercials and perhaps replace them with public service spots informing people about health and disease. TV viewers might better understand what the hell goes on in their bodies, prompting them to take better care of themselves, and empowering them to use the Medical system more wisely. Maybe we should also spend a few more dollars and hours teaching kids about their health as well!
17. If you go shopping, likely they will not let you leave the store with your purchases until you pay for them? But, it's okay to forget your wallet-checkbook-credit card combo when going to the Doctor's office! If I see a patient, and only once at the checkout window they indicate that they can't pay today, can I have them arrested for shoplifting?...oh, right!...they'll send a check!
18. There are currently about 15 'sharps' in my "red box" at the office...but the average Diabetic leaves 10 times that at the curb every month! I pay a fee (tax?) as a "Medical Waste Generator", AND then pay to have the boxes carted away as well...that's seems about right!
19. If I worked for a Company...let's say, a Wall Street firm...and I did half of a good job, I'd probably get a raise fairly regularly, and perhaps, an occasional promotion. Not in this job! My take home has fallen year after year as my overhead has risen! AND, I earn the same paltry dollar amount for each service that a Doc fresh out of school or residency would get. No disrespect, but my 25 years of experience frequently has me doing the job ... dare I say ...better ... and more cost effectively. And the Doc 40 years in practice?...(yikes!)...should be a few pegs up from me!
20. Who decided that the fee for "stick out your tongue and say ah" was "bend over and drop your pants"? Why should Congress both decide MY PAY, and also set and regulate their own salaries? Isn't that a bit backwards? I should set MY FEES, and WE should determine their salaries!
The problem with the health care system is cost, not quality. We all know of poor patients who were unable to pay who still received top of the line treatment.
Follow the money! especially the money with no value added for health or well being of patients. I tried to ascertain how much reducing Anthem's excessive costs could lower premiums. I was unable to get the number of Anthem subcribers in the state of New Hampshire, either through direct inquiry or through a local newspaper reporter. If you took the $30 plus million bonus from 1 CEO in 1 insurance company and divided that among the subscribers, you would be able to lower premiums by hundreds of dollars. This would make health insurance more affordable for those "on the fence", which is a large percentage of the uninsured. Go through the same math industry by industry and money is there to be saved.
Instead the politicians stay away from those that give them money and try to cut fees on everyone else. The politicians have corrupt motives and should not be allowed to "fix the problem". They are not addressing the problem correctly,only trying to get re-elected.
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Indict corrupt Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition! Allow interstate sale of health insurance with more competition, lower premiums, portable policies, and better deals for docs.
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills. Prevent him from superimposiing Medicare Reimbursement onto private Health Insurerance CO's which is simply a disguise for a new "Public Option"; there will be more garbage to follow.
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
Inform your patients who vote by whatever means possible, the media could care less as they love B.O. Go on the Million Med. March to D.C on 10/01/09 if youcan. Have your own Town Hall with your patients. The fight against the British overlords began with a few farmers in Lexington and Concord; can't we fight back like they did with our actions and words??? (Forget T. Kennedy, think Dr Albert Schweitzer.)
I am considering leaving my primary care practice, I'd like to tell you why. Although, it has been only six years since finishing my training, I am seeing my colleagues leaving the field. In our office of eight physicians, three doctors left in the last several months. Many medical students and doctors are looking for work out side the realm of patient care. I am one of them.
The longer I do this, the more I have come to understand that listening is the most important thing I do as a physician, it is not high tech but to be heard, reallly heard, is critical to healing. Unfortunately this is not what is valued in our current medical climate.
Physicians who spend more time with patients are considered under productive.When did medicine become another production model and when did patients become units of production? A recent article from a popular physician business journal recommends that doctors give up their lunch time, eating on the run so as to see more patients and be successful. Am I the only physician who thinks this is crazy? Lunch time is my opportunity to catch up with paper work and return phone calls. As it is I have taken a second consulting job to try to keep up with expenses. I have made a priority of spending time with my patients, but I don't believe I can afford to stay in business much longer.
I was disappointed to see our local spa charges more for make-up consults, hair coloring and perms than I see from Medicare for my services. Since graduating from medical school, doctors have been battling with Medicare to prevent the projected paycuts based on the SGR. With the impending cut of 21% to physicians in 2010, frankly I just don't have the stomach for it anymore.
Everyday has become a struggle. Irate patients swear at my office staff when insurance denies coverage for prescriptions or referrals I recommended. The patients identify their physician as the face of medicine and take out frustrations on my staff and I frequently. Although my biller has become resigned to this behavior it is not right. I have found that there is a general sense that medicine is just another consumer product. Patients expect to call up and get treated for free over the phone so as to avoid an ever rising copay. I find it sad that they do not even realize they are asking for substandard care. I still think there is a lot of value in the medical exam and observations made while you are interviewing the patient but today people place very little value on that and have come to accept less.
Then there is the issue of fear. Everyday I have to wonder if this is the day I get sued. This fear drives up the expenses related to our health system. Patients have come to expect a high tech eval for every symptom and physicians are afraid to deny their requests.
I would like to work toward improving our health care climate. It is imperative that those of us working "in the trenches" are part of the discussion. I fear a collapse of our primary care base and that will be very sad indeed.
My head is swirling from so much information, and I'm trying to make sense of it all from the various prespectives. I am not in private practice. I have always worked with uninsured/underinsured populations. I see the people no one else will see, and that is overwhelming. . We have more patients than we can take care, which is scary from the perspective of making sure we're not losing track of them. If I find my patient has a far more serious problem I can't find a specialist who will address their medical problems. Some patients have a "Basic Health Plan" sponsored by the state. It takes care of their basic needs, but if they have anything beyond a cold or I find an abnormality on a physical exam, then it won't be covered. I just don't want to see more of the same but on a broader scope. Is this being addressed at all?
Medicine is a God given, healing profession. Don't quit. Don't give up the good fight. I thought I'd quit 20 years ago but stuck it out for 45 years! There's nothing greater you can do despite all the obstacles.
Remember the farmers at Lexiongton and Concord where our Nation was born! Can you say " I've just begun to fight"?
"Extortionists" is what one person called us on this website - blogs.sulekha.com (search "cap for doctors", then read blog "there must be a pay cap for doctors too").
About half the patients I talk to about this seem to appreciate the need for appropriate reimbursements and salaries for physicians and they have an appreciation for how hard we have worked. Maybe half is a bit high and it might depend on where you live.
There must be some financial incentive to appeal to the brightest undergraduates interested in medicine. Or they will do something else. Unfortunately, a lot of patients compare our average salaries directly to their salaries and think that we must be quite comfortable. Obviously not comparing apples to apples. But can we expect the average person to understand the meaning of opportunity costs? What does the public think is the average educational debt burden for med school grads? And if they knew, would they care? Some of them have already decided that we are the problem because they feel we benefit immensely from their suffering.
Maybe a large poll of random patients would be helpful. With questions such as: What is the average med school debt, total years of training to become a physician, average physician salary, time a physician spends working on their case besides face-to-face time, etc etc. This might be publishable when compared to the facts. And for the ones who are not moved by the stories and letters from physicians who will be closing their doors, it might be more informative when opinions vs facts are compared side by side.
Sadly, Americans might have to experience poor quality healthcare that we'll ultimately see within a couple decades if govt run healthcare is initiated. The system will continue to ride the wave of quality care brought about by years of advancing technology and research and by caring physicians who will continue to treat their patients. The change might be slow. Eventually, the public would want the current system back, but would be near impossible with govt in charge.
Doctors will probably not starve even if the government takes over health care. The people who will suffer will be the patients.
I have worked at the Dallas VA, at Parkland, the county hospital in Dallas, and at JPS the county indigent health program in Fort Worth. I can't say pt's didn't get care. They did. But what they suffered through was government employees who were often rude, long waits, inefficiencies of care delivery. That is what you will always get in a government run health program.
As our President and Congress struggles towards a solution for our national health care crisis, the people of Ohio are left to wonder if those in Washington, DC understand their predicament with the rising costs and diminishing access to health care in their own communities. Some would argue for a one-payer universal health care system, sweeping aside the current system and setting the table for government defined limits on care. Others would demand for the status quo, leaving health care in the hands of the administrators from health insurance companies and those at CMS.
Few would however, argue with their physicians' knowledge of health care and the challenges of managing their patient's health in an every changing and dynamic world of medical innovations, limited only by the costs of those advances. Physicians in Central Ohio formed the only physician owned and managed health insurance company in Ohio, we uniquely placed the physician's voice squarely in the center of a health insurance company intended to bring affordable evidence based medicine to the citizens of our state. Rather than being driven by Wall Street analysts' quarterly dividend reports, The Physicians' Assurance Corporation (TPAC) reached out to employers since its inception a year ago, and worked towards tangible costs savings goals with wellness programs. Also included in their model were instituting peer review panels, clinical integration programs, credible pay performance measures, creating Health Care Alliances. Despite growing quickly to insuring over 8,000 citizens in Ohio within its first year of business, TPAC faced a capitalization crisis. They anticipated being at a break-even point second quarter of 2010 and in the mean time was not able to fulfill the state's minimum surplus. As a result TPAC was forced to liquidate by the Ohio Department of Insurance last week. We ask for your assistance to add your voice to ours and continue the mission that the physicians in Central Ohio tried to start - offering a physician driven solution to the health care crisis in our country. It is our belief that the continued implementation of this model will provide some answers to many of the questions and dilemmas facing health care and health insurance in the coming years.
My 14 year old nephew while walking down a rural road (walking in the direction of the traffic) was hit by a car driven by an 18 year old boy who crossed the medium (double yellow line) going 45mph striking my nephew from behind. He was resuscitated and after 2 weeks in a coma and craniotomy suffered diffuse axonal injury. After 3 months in the hospital because he wasn't making progress in his rehab (due to being overly sedated) he was discharged from the hospital just 5 days after having his skull bone put back into place. Because he lived more that 6 hours from a major city he never had a visiting nurse or daily access to rehab except for the care by his parents (both high school grads). The trip was to hard to take as my nephew could not sit or stand, had a feeding tube in place, was unable to communicate well.. My sister works full time and rapidly ran out of days off to care for her son, insurance coverage and now faces extensive hospital costs as well as the costs to care for her son. The individual who hit her son only had $50,000 in insurance coverage and the insurance company is claiming the child was 50% in the wrong for walking on the side of the road and will pay only for 50% of the costs (this is in California, my sister lives in McArthur ). No lawyer is interested in representing her because there are no deep pockets to delve into and take 40% of the booty. He is now free of his feeding tube, is walking wth a cane, can't use his left hand and has trouble with his speech. Instead of starting 10th grade he will go to 8th grade. This is definately an area that Health insurance reform needs to address - catastrophic coverage. Insurance companies need to provide affordable premiums to all (especially to families with young children) that could be supplemented by the government for families who make less than a certain income. For a famlly of 4 lets say $125,000 like they do with flood insurance. If they want to fund the program by taxing individuals who have premium health insurance policies than that's okay with me. Unfortunately, the unions would be against this as they provide their union members with cadillac policies and that is why Obama and liberal democrats are against this . Let families and individuals select the kind of coverage that is right for them but requiring catastrophic coverage be provided as a minimum benefit at an affordable premium and allow cross state access to insurance policies to enhance competition. The feds should look at best practices for insurance companies and regulate beneficial insurance reform, tort reform and providing coverage for those who can't afford medical care (unemployed, the poor and catastrophic events). We don't need an overhaul of the entire system and the government invading the privacy and choice of what physicians and their patients decide what is right for them. After all we did take an oath to do no harm. It's obvious that our politicians have not.
Enacting real tort reform would save billions in health care costs. The concern by physicians over a missed diagnosis and a potential lawsuit results in numerous diagnositic tests, many of which are probably not necessary. Once this type of defensive medicine becomes engrained in the daily practice of medicine, it is repeated day after day with patient after patient by most if not all physicians in this country. This results in much more expensive health care, not better health care.
Meaningful tort reform could drastically reduce the cost of medical care by reducing the number of tests ordered in the practice of 'defensive' medicine. Obama has suggested his reluctance to enact tort reform is because it might hinder an injured patient from obtaining compensation. Far be it from me to suggest this reluctance has anything to do with Democratic backing by trial lawyers. Perhaps a government backed malpractice insurance program (similar to the VA) could be devised such that the cost of malpractice premiums would be taken off the back of the physician which would go a long way in lowering physician's concern. Something akin to a "3 strikes and you're out" clause could remove physicians who have a reason for concern regarding their quality of care. But just to bury one's head in the sand in regards to the true cost of practicing medicine (as Obama has done) defies logic.
I would never trust a politician and especially a leftist politician to have the compassion and caring and selfless commitment that is required to be a practitioner of health care. We as American physicians have to commit to a better solution, it is going to require everyone's input and much focus on using the health care dollars efficiently. One of the best ideas is health care saving accounts, that puts the motivation and control in the hands of the people receiving the health care. It also gives them incentive to live healthily. Hopefully we will have leadership in this area that will call everyone to the table, realizing that human nature is being what it is will tend for an easy way out. Health care is not a right but a responsibility of us all.
Middlemen and middle agencies destroy the Dr.- Patient relationship by disrupting to the point of destruction, the physicians ability to, with the help of technology and the Almighty , heal the sick patient in need !
I am from Rockford. IL. This State has has lots of brilliant physicians. I am amazed why only 319 have so far signed the appeal from our State. It is my request to all the physicians of Illinois to please take some action on this appeal.
Enough is enough! It is high time that our government recognizes the thoughts and wishes of the two most important "players" in this healthcare "game," the patients and physicians! Enough political posturing and deference to monopolistic insurance giants and trial lawyers!
2 key concepts must be addressed ( and for some reasons are not being addressed) :
1. tort reform
2. one health payer system - sounds radical but it must be done to do away with the $31 billion / year insurance bureaucracy - all the think tanks are on board with this.
this is ridiculous (the proposals). it is sad, however, that it has taken times as drastic as these to unite us. I hope we come across as a united front, but im afraid the few who choose to support obama will get the majority of the press.
without medicine being an attractive job for those with smarts, you're going to have a potentially drastic drop in quality of physicians.
Billions will be saved with tort and malpractice reform. Obama and his cronies/trial lawyer buddies know it though refuse to do anything about . What a sad time in our nation's history.
Health care costs could be decreased by using a universal insurance form. Not having to reprogram office computers with specific forms for each Insuranse company could increase efficiency and decrease reprograming costs.
The fact that 12-14% of the GNP has gone for medical costs since the early 80's hasn't changed--it remains the same. But reimbursement to physicians steady has decreased. Now the money is deverted to peer review, rehab managers, and other agencies that "control costs". At the same time, insurance costs soar while patient benifits and physician reimbursement steadily decrease. Don't blame the physician it is the insurance companies that need top be investigated and managed. But then again, they have a pretty good lobby--so most likely nothing is going to happen.
Cost containment is best managed by not having to practice defensive medicine. This can only be approached by tort reform.
In most cases, you don't need an MRI to know when a patient needs surgery. But if a diagnosis of a tumor is delayed in this manner, a physician would not have a legal leg to stand on. If the goverment is planning to decrease costs by "managing" care, the physicians would have to be legally protected, otherwise they would have to be crazy to participate in such a plan.
And the government is good at managing:
air traffic control,
banking,
the auto industry,
a balance National Debt,
and health care....
WHO DECIDED THAT?...and do you remember voting on any of the above.
A balanced National budget, term limits, and the line item veto are all things that need to be worked out before National healthcare has a chance of being successful.
If you want a National Health care plan--with ability to have access to the best medical system, physicians, equipment and hospitals in the world, It has to be well thought out, and cannot just be pushed through Congress just because it is on the agenda. But as my dad said: "Common sense must be a special gift from God, because so few people have it."
Having been in surgical practice for 30 years I have seen my share of malpractice cases. Most cases are as a result of a less than desired outcome. Many times disasters occur in very ill patients that were not the fault of the Sermo Doc 102. Often these disasters produce severe financial loss for the patient. Why can't these patients receive some form of compensation (or at least coverage of their bills) due to the disaster without having to assess blame.
Lawyers argue that it is the blame that keeps the system clean by weeding out bad doctors., What if the state licensing agency reviewed all disasters that occurred. Those would be categorized (as is done at M&M conferences at our hospitals and universities) preventable or nature of the disease. Preventable can be further subdivided into errors in judgement and errors in technique. Should a physician make too many preventable errors, their license might be revoked or remedial action recommended. Problem solved.
A final plus is there are some doctors that have catastrophe after catastrophe but for some reason don't get sued so they stay below the radar. They would be uncovered with catastrophic insurance.
The best part is it would be part of regular health insurance so no premiums for the doctor. The insurance would be funded by the enormous savings by eliminating depositions, expert witnesses, and jury trials - we are talking multi-millions.
So - I'm told the lawyers will never go for it. Like what else is new. How do we get our legislators to buy into this?
The other evening I went the town hall meeting scheduled for 7PM in Reston, Virginia at which Congressman Frank Wolfe was present. I arrived about 7:10, to find that there was no parking within nearly a mile of the meeting site, with cars parked along just about every road in the surrounding area, many from Maryland. I never got to the building, but most people I saw were carrying posters clearly skeptical of the health care proposals being promoted by our federal government.
I am a clinical neuroSermo Doc 102, in active practice, and graduated from medical school in 1968. I have practiced in the military, in an academic setting, and in private practice, and by this time have seen about everything. I have also watched the inexorable deterioration in the physician's ability to care for his patient over the years. In the early 1970's I heard the phrase over and over again "healthcare is too important to be left to the doctors." Well, we now have in the hands of politicians, lawyers, and business administrators, and I don't think we're any better off. In fact, every time any one of these entities meddles further, things get worse, and today healthcare is probably the most restrictive industry we have, and patients have not benefited from this. So, I am happy to see this amount of public involvement.
It certainly is time for a change, but not the change envisioned by our legislators. Had I made it to the meeting, one of the things I would have asked about is the proposed "single-payer program," I believe a disingenuous proposal. The fact is medicine has always been a single-payer program, and that payer is you, dear reader, the patient (read "taxpayer," if you wish). What is really happening is that there is now a great debate going on as to who gets to be the intermediary, the entity that controls the flow of money between the recipient and payer (you) and the provider (me, or a hospital or other such facility). Up to this time the intermediary has evolved into either the government or an insurance company or similar entity. The government, especially the government we seem to have voted into power this cycle, seems the more ominous of the two, because in assuming this power the government is edging toward defining life itself, which it clearly is already in the process of attempting. Personally, I think this is dangerous, but that in no way exonerates insurance companies or other such entities. As the alternative intermediary, the insurer is simply the lesser of two evils, and that includes all kinds of insurance, even malpractice insurance, also known to us as "the lawyer magnet," a closely related issue receiving scant attention in the most prominent proposals.
But the real question to the American public is and should be "why do we need an intermediary at all?" We were doing quite well before the introduction of third-party payers. And, we have always had charitable institutions, as we still do, to take care of those who could not afford to pay. The word "charity," however, is unpalatable to some, and so we use the word "entitlement," engendering a remedial program, and of course once again we have burgeoning intermediaries to administer such programs.
I hope we as citizens have come to recognize finally that all of these intermediaries are siphoning off too much of the money and more importantly at a deeper level, too much of the power. It is time to ask, critically, if they were ever needed in the first place. The introduction of third parties into medicine was not the answer. Now, it is the problem.
I just signed the appeal using my real name. Sermo is a GREAT idea. Physicians, as a group, have long been ignored. We must stand together regardless of our individual specialties. The AMA is useless and politically driven. It will NEVER honestly represent physicians. Thank you Sermo!!!
Sermo Doc 32 - just an FYI, in alot of European countries, medical school if free of charge!!!!! How about that for a start. Maybe if we didn't finish school in debt to the government that doesn't want to pay us, we'd be better off. It's gotta start somewhere, why not encourage more primary care and repay those loans of residents who graduate and stick around in the areas they trained (or go to less fortunate areas), reward them all for staying for 4 years. Or of those who in turn teach medical students without other financial compensation.
Items 1, 2, and 3 are fine. The implications of item 4 leave me uneasy as to its real intent. Is it to increase physician incomes across the board? Is it to decrease the disparity between primary care and highly specialized docs, or between rural and urban docs, or docs in different regions with large differences in cost of living?
Since item 4 doesn't directly conflict with my beliefs, I'm signing the appeal. But I'll be meeting my Senator in a Town Hall next week and will urge him, as I have already urged Obama, to regroup and get a single-payer non-profit system on the table--something like Canada's was in its first 25 years before it was sabotaged and eventually eviscerated by private-interest administrations and lobbying from the insurance industry resulting in "creeping privatization." Shopping for health care should not be the same as choosing between steak and bologna, or trying to predict your medical needs and life situation five years into the ftuture
Private insurance is to health care as Haliburton and Blackwater are to military policy and operations. Capitalization has a crucial place, but not in the delivery of health care..
After 22 years in family practice, (a practice I started in 1980 and which added 2 doctors), I was getting burned out. Burned out by insurance companies
(no, not that ACE, only this ACE is covered) and by non-doctors giving "report cards" on my excellent charts (Medicare once refused to pay for a pneumovax, because the nurse did not initial it was actually "given", though I had written the order......oops, Medicare....now I have to absorb the cost of another pneumovax). And of course, trying to convince an HMO that a patient really does need an MRI on their knee which gives way on the stairs
Seven years ago, I started a full-time, non-profit medical Clinic for people without health insurance. No other rules. No financial screening. No government money. No geographical boundaries. Simply high-quality care in a lovely setting for persons without insurance. Payment as each can afford.
Now, with very busy practice, we have FP, IM, Gyn, Derm, PT, psych, Peds, Uro....apart from two paid doctors, ( 1 and 1/2 actually), all others are volunteer. We have 150 acftive volunteers (clerical and clinical). We have 1000 patient visits a MONTH now.
And when people finally do get insurance, they don't want to leave, as more than one of them has said "I've never been treated as well as when I've been here.....you all actually LISTEN to me")
Of course there are problems: it is well nigh impossible to get a non-emergency surgical problem fixed; we have a man walking around with a huge LIH with a big truss, trying to work full-time as a pizza maker, but he cannot get it fixed as he makes too much for medical assistance and cannot afford to buy insurance privately.
And we have a woman with gall stones and intermittent severe pain, but cannot get it out for same reasons.
But the joy of going to work and NOT having insurance forms, formularies, HMOs etc etc etc is great, and I am enjoying medicine as never before
I am not signing the appeal because I disagree strongly with the first item. Insurance premiums vary reciprocally with interest rates. When interest rates are low, insurance companies have to increase premiums in order to keep their reserves -- the money they use to pay claims -- at an appropriate level. The then seduce physicians into thinking the plaintiff's bar caused the problem, and lobby for 'tort reform' in order to assure they will not have to pay the full value of legitimate claims. That seems to have happened in respect of the drafters of this petition. I cannot support this maneuver.
We do need no-fault insurance for adverse effects, the inevitable few bad outcomes of good and appropriate care. People who had bad outcomes may sue simply because there is no other source of funds to pay for their disability . . . and giving these individuals economic compensation outside the tort system would instantly and permanently reform that system.
By coincidence today, I was wondering today what our Great Indian Nation, including a relative, might think about Obama Care and chanced upon this from the WSJ:
Montana Sen. Max Baucus, a leading architect of national health-care reform, visited the Flathead Indian Reservation near Pablo, Mont., in May, and he was confronted with a surprising critique. "I hope any [new health-care] plan does not forget the nation's first people," Dr. LeAnne Muzquiz told the senator. Another person in the audience, according to the newspaper the Missoulian, followed up by telling the senator that the legislation pending in Congress would in fact do just that.
Native Americans have received federally funded health care for decades. A series of treaties, court cases and acts passed by Congress requires that the government provide low-cost and, in many cases, free care to American Indians. The Indian Health Service (IHS) is charged with delivering that care. The IHS spends about $2,100 per Native American each year, which is considerably below the $6,000 spent per capita on health care across the U.S... about on par with Finland, Japan, Spain and other top 20 industrialized countries.
Unfortunately, Indians are not getting healthier under the federal system. In 2007, rates of infant mortality among Native Americans across the country were 1.4 times higher than non-Hispanic whites and rates of heart disease were 1.2 times higher. HIV/AIDS rates were 30% higher, and rates of liver cancer and inflammatory bowel disease were two times higher. Diabetes-related death rates were four times higher. On average, life expectancy is four years shorter for Native Americans than the population as a whole. Rural Indians fare even worse. A recent Harvard University study found that life expectancy on a reservation in neighboring South Dakota was 58 years. The national average is 77.
Horror stories are common on reservations, where the common wisdom is "don't get sick after June"—the month when the federal dollars usually run out. In July 2008, the Government Accountability Office reported that the IHS simply lost $15.8 million worth of equipment such as trucks and Jaws of Life machines between 2004 and 2007. It also found that $700,000 worth of computers were ruined by bat dung.
The Chippewa Cree Band has opted to provide its own health care with funding from the IHS. Dr. Dee Althouse, a physician at the Rocky Boy's Reservation, is still frustrated by funding constraints. She told the Montana Quarterly that she often finds herself working to save lives and limbs, deferring routine health care until there is money available. Yet even with limited funds, ongoing research by the Native Nations Institute reported earlier this year that tribal management leads to better access and better quality care than relying on the IHS-run system. The Chippewa Cree Band runs its own hospital and has hired a registered dietician who has gotten the local grocery store to implement a shelf-labeling system to improve consumer nutritional information. They've also built a Wellness Center with a gym, track, basketball court, and pool. These are small steps that won't immediately eliminate heart disease or diabetes. But they move in the direction of local control and better health.
At a time when Americans are debating whether to give the government in Washington more control over their health care, some of the nation's first inhabitants are moving in the opposite direction.
•(Mr. Anderson is executive director of the Property and Environment Research Center in Bozeman, Mont., and a senior fellow at Stanford University's Hoover Institution. WSJ OPINION: CROSS COUNTRY, AUGUST 28, 2009, 6:44 P.M. ET.)
So then, if our Indian Nation cannot survive under the present Government System, God help them under Obama Health Reform. Please sign the Appeal, I did.
"We pledge to be partners in true healthcare reform, improving the healthcare delivery system in this country while honoring the Hippocratic oath that we all have taken."
I am not signing the petition. The above quote implies a legitimate role for government in health care as a partner in seeking our goals. That is wrong.
There should be total separation of the government and medicine and I belive this petition will undermine the objective of totally free markets in medicine which should be the goal of all physicians and patients.
I tend to think that this appeal is more for doctor self interest than for patient's interest. I cannot sign this. I think a clearer idea of the problems with US healthcare is seen in the movie at :
www.pbs.org/moyers/journal/08282009/watch.html
Increasing interventional proceedure Medical Care will lead to bankruptcy. Medical care, at it's heart, is one on one, listening and talking, showing the loving care to work to ease the suffering of the patient.
GOP senator signals fading hopes on health care
AP - By JIM KUHNHENN, 2 hrs 38 mins ago
WASHINGTON - A leading GOP negotiator on health care struck a further blow to fading chances of a bipartisan compromise by saying Democratic proposals would restrict medical choices and make the country's "finances sicker without saving you money." The criticism from Sen. Michael Enzi, R-Wyo., echoed that of many opponents of the Democratic plans under consideration in Congress. But Enzi's judgment was especially noteworthy because he is one of only three Republicans who have been willing to consider a bipartisan bill in the Senate. He called for more competition among health insurers, for the ability of small businesses to band together across state lines to negotiate for lower-cost insurance plans, for tax breaks to help people buy insurance and for reducing malpractice lawsuits. "The Democrats are trying to rush a bill through the process that will actually make our nation's finances sicker without saving you money," Enzi said. Democrats also are calling for cuts in Medicare spending, using some of the savings to help uninsured workers. A House bill would result in a net reduction in Medicare of about $200 billion, though Obama has insisted the reductions would not cut benefits in the health program for the elderly. But Enzi said: "This will result in cutting hundreds of billions of dollars from the elderly to create new government programs." "We're a nation of people who want the ability to choose what will best fit our families' needs and it should be that way with health care, too," Enzi said.
Perhaps we've got a chance for starting over proper reform!
THE APPEAL SHOULD INCLUDE NOT DESTROYING THE GOOD THINGS WE HAVE IN OUR SYSTEM AND MODIFYING WITH THOUGHT, PATIENCE AND DUE DILIGIENCE THOSE THAT NEED CHANGE. LET'S MODIFY HEALTHCARE STEP BY STEP. GOVERNMENT SHOULD NOT BE INVOLVED IN HEALTHCARE ANY MORE THAN IT IS NOW. AT THIS TIME WE STILL HAVE THE BEST HEALTH SYSTEM IN WORLD (FACT : PEOPLE FOM ALL OVER THE WORLD COME TO THIS COUNTRY FOR TREATMENT AND PHYSICIANS FOM ALL OVER THE WORLD WANT TO PRACTICE HERE.) LET US NOT DESTROY IT. YOUR APPEAL DOES NOT ALLOW FOR PHYSICIANS THE ABILITY TO DIFFER OR DISAGREE .AS SUCH PLEASE LEAVE ME OUT OF IT. RFE
I wont sign because it is vague and sounds self serving. You could have change #1 to read something like:
Reduce physician overhead and eliminate defensive medicine costs by completely doing away with the tort system of malpractice. INSTEAD, substitute a system in which complaints of malpractice are evaluated by a team of physicians, lay people from the community, and others to result in two outcomes whenever genuine malpractice is found;
1. A system of compensation for the injured party. 2. Practice penalties for the physician up to loss of license. A lesser degree of culpability might result in a limited licensure with active, vigorous, on the spot supervision of similar cases (compensation going to the supervisor, not to the offending physician).
Without some kind of explanation of the alternative that you propose to each of your points, it really is unacceptable, at least to me. And believe me, I have had just as much difficulty with managed care, reduced reimbursements, malpractice garbage, etc., etc. as anyone else.
How to help this nations' healthcare and preserve our ability to freely practice: Go to town meetings, ask to be interviewed and write for local newspapers and news stations, raise money and campaign for any politician who is NOT a liberal, 'progressive', or Democrat. Speak openly to your patient's: counsel them regarding the fatuous, misleading and dangerous 'talking points' and false statistics that come from the tainted mouths of Democrats and from the affirmative action, arrogant socialist Jimmy Carter-lite, Obama. Be loud. Fight!
At this point, we need to get behind one concerted effort to DEMAND tort reform before we go forward. Many of us have different opinions about healthcare reform but I have yet to witness any practicing physician (not assoc with the trial lawyers) who thinks the current legal climate is acceptable. It is time to draw a line in the sand. If we don't take on the trial bar, no one will because what Howard Dean said is true!
I am fed up wit government interference and price fixing. Work without pay is slavery. I thought we struggled 200 years to end this custom and here we are trying to reinvent the wheel
I agree and we also NEED a competitive health option for those who can not afford the non-competitive health insurance premiums today. Reform MUST START or we all(patients and physicians) face some difficult times ahead.
Sermo Doc 382, I agree with you completely.
We need to let our voices be heard as loudly as possible. Talk to your patients as they're the ones who vote! Set up Town Halls or Tea Parties, write letters, send faxes, and do it overe and over, not just once.
Together we are a loud and powerful voice. We can and will be heard!
Fight the GOOD fight!
Sermo Doc 284: Thanks for the support. One of the problems with our community is the fact that most of us are just grown up versionsof the quiet, reserved and studious nerds we were as children and students who are not used to taking assertive and loud positions to protect ourselves, our families, and our patients. In this regard, a patient of mine remarked that SERMO's valiant head appeared like a "sad, placid nerd" when he was on TV. It's not his fault. We have to rise to the occasion and be something greater than ourselves. Sadly still, there are many of us who are naive adherents of politically correct, but scientifically incorrect and often self-righteous patronizing liberal/'progressive' positions that are destructive to our profession and the nation's overall health. Those of you in our community who displayed such short-sightedness and ignorance by fashionably voting for Obama and his socialist Democrats should be most ashamed. Repent by making your voices the loudest. Surely you realize now what a foolish and dangerous mistake it was to vote for these 1930's retreads.
Sermo Doc 382, apparently there are some docs, even in Congress who are only out to line their pockets. Remember Dr. Frist?
Seems like Dr.Frist's Senate service had been about nothing so much as profiting from the suffering of the nation. By blocking needed health care reforms, pushing for tort reforms that would limit malpractice payouts and supporting moves to privatize Medicare, Frist pumped up his family's fortunes at the expense of Americans who lacked access to health care. As Mother Jones explained, "Some companies hire lobbyists to work Congress. Some have their executives lobby directly. But Tennessee's Frist family, the founders of Columbia/HCA Healthcare Corp., the nation's largest hospital conglomerate, has taken it a step further: They sent an heir to the Senate. And there, with disturbingly little controversy, Republican Sen. Bill Frist has co-sponsored bills that may allow his family's company to profit from the ongoing privatization of Medicare."
The Frists fared well during the senator's two terms. An $800-million stake in HCA that his father and brother had at the time Frist was elected in 1994 shot up in value over the decade that followed. Frist's brother, Thomas, rose steadily on the Forbes magazine list of the world's richest people in recent years. In 2003, Forbes estimated that Thomas Frist Jr. was worth $1.5 billion. According to Forbes: "source: health care."
Corruption is rampant in Congress. All of us together can weed it out!
An economic plan alone will not fix the problems with medical care in this country. Not all of the system is broken. One should not tear down what is good and replace the entire system. One should look at what is good and expand the good as well as eliminating the bad. Individual freedom of physicians and patients is important in our free society.
I signed wholeheartedly by name and do feel that the major issues were adequately addressed in the appeal. We need to be stronger in making sure Congress puts
limits to the thiefs in the insurance industry. There should be no reason for denials and no claims conveniently ignored anymore. The insurers need to finally be held accountable and actually pay the doctors and hospitals for services rendered to the patients they have agreed to cover. INSURANCE REFORM!! Talk about saving money... Millions of dollars could be saved by not wasting valuable time and money on appeals, phone calls, certified letters....
I have been tangled in a medicare nightmare and have for the first time in my life felt like Big Brother really is watching. I have never thought of myself as paranoid, sometimes not even locking my doors at night. I know that I am an honest and ethical person, as I believe the VAST majority of physicians are. However, I feel that physicians have NO power anymore--we are like indentured servants. I welcome the chance to finally have a voice. I just want to practice medicine and take care of patients. I'm not looking to get rich, but I would like to have a decent salary and take care of my overhead as well as have time to read journals, not to have to pour over constant CPT updates, changes, etc... or spend time fighting with insurance companies just to get the reimbursement the beneficiary thinks he/she is covered for.
Rep. Shadegg: Obama Misleads on Healthcare
Wednesday, July 29, 2009 3:01 PM
By: Ronald Kessler
President Barack Obama has been making misleading claims about his healthcare proposals, Rep. John Shadegg, an Arizona Republican, tells Newsmax.
Shadegg, a member of the House Energy and Commerce Committee, notes that Obama said in his speech on healthcare reform that the legislation he and congressional Democrats propose "will keep government out of healthcare decisions," and Americans will have "the option to keep your insurance if you're happy with it."
In fact, Shadegg says the House bill "inserts the federal government and federal bureaucrats in virtually every healthcare decision in America. And, under the clear terms of the bill, you will not be able to keep your current plan, whether you like it or not."
Shadegg sees the House bill as a "massive takeover of every aspect of healthcare." The legislation "empowers bureaucrats to make virtually every decision," he says. "It creates a new healthcare advisory commission, a new healthcare benefits board. It creates a new commissioner who would have powers just short of the powers of the president.
It dictates what must be contained in every policy in America, down to what they must cover, what appeals process it must have, all the way down to how insurance firms must advertise in a manner acceptable to the federal government. It is a massive federal government takeover where bureaucrats and the government will be involved in every healthcare decision."
Ronald Kessler is chief Washington correspondent of Newsmax.com.
www.newsmax.com ===
So, we either stand up and take action as Sermo Doc 382 has stated or live in more misery with ObamaCare! You will have NO SAY WHATSOEVER and will be subject to revocation of your license and/or fines if you don't follow his Regs.
"PCPs in all other countries with socialized medicine make even less than American PCPs. In the eastern european block they drive cabs for spending $. In Britain they have side private offices. In Canada they go to Florida for two months a year when the $ stops."
I would like the sources of this information please. Thanks.
privpsychdoc and Sermo Doc 389: You have it made as Psychiatrists!
You both could be a "Doc in a Cab" whereby you could provide a Medical Service while driving a cab. You could collect the Medical Bill and the Cab Fare, both for cash!! No Government Plan, No insurance co. No HMO. Why not?!
We need to be heard. It seems that all the proposals are from law makers, lawyers and politicians, and even insurance companies. Largely, the physician view has been ignored. What is wrong with this picture?
The government contractor for Medicare in California did not pay us for six weeks even though we had told them when we were planning to move our office before then. They kept putting us off, claiming that we couldn't prove that we had moved. After a few calls that my office manager made, she was told that if she kept calling that it could take even longer to sort things out. After a few other calls, (explaining that we could not pay our staff if we didn't recieve our medicare payments) the person who she was speaking with said "I don't care" (a direct quote). I then spoke to another person in that office and immediately thereafter had an anginal attack, and ended up having 3 1/2 " of stents placed. Now I'm doing locums. THE HEALTH CARE BILL WILL ONLY MAKE THIS MORE WIDESPREAD.
I am a General Pediatrician in private practice in Nassau County, NY for 28 years and I'm on the verge of bankrupcy. I graduated Columbia College, Johns Hopkins Medical School and did my Pediatric Residency at Albert Einstein in the Bronx.
Why am I bitter?
Why am I verging on bankrupcy? I have no control over the price I charge for my care that I give my young patients. I either accept the fee offered by the insurance company or leave their panel. 99% of my patients are enrolled with HMO type of insurance. If I leave their plan, they would leave my practice, even though they "love" me as a caring physician.
Less than a year ago, a 17 year old patient developed Hodgkins' disease. I strongly advised they choose the oncologist I knew was one of the best doctors I've ever met to treat the disease; he graduated from Hopkins with me. My friend cured their son. They were grateful to me for all the (unpaid) time I spent advising them. But last week they were annoyed that they had to pay another "co-pay" of $15 when the young man developed a dermatitis and came to me for treatment. This dermatitis looked a lot like poison ivy or latex sensitivity around the wasteband. However, considering the young man's history, I was more concerned and looked at the rash very critically.
This is the stress the primary care doctor is dealing with. The family actually doesn't understand that I dont "charge" a co pay; I "collect" the co pay THAT IS DEDUCTED FROM THE $50 FEE THE INSURANCE COMPANY THINKS MY EXPERTISE IS WORTH.
Tort reform MUST be HAMMERED home in any reform. THE IMPOSSIBLE COST of medical care is DIRECTLY tied to DEFENSIVE medicine. Every doctor is at risk of being blamed if anything bad happens to a patient. A lawyer is waiting for every unfortunate outcome.
Sermo Doc 392: I see physicians in similar posiiton all the time. Undortunately if doctors keep asking for "TORT REFORM" we might get it. Capping malpractice awards WILL NOT reduce cost of defensive medicine or your stress. See comments in this and other posts about NO FAULT type of insurance for medical mishaps.
Addendum
I didn't expect to be making $140,000 with 6 days worked each week at the age of 56.
Am I greedy or lazy that I want to be making as much now as I did in 1987?
PRIMARY CARE DOCTORS ARE GETTING SLAMMED?
In fact we are now calling ourselves "PROVIDERS" as the insurance industry has come to call us and the physician extenders.
The insurance industry leaches have to end their control.
Do you really think the American people will respond to this Appeal? Read the following:
Obama Socialism:
"Obama had the 1000 page "Healthcare Reform Bill" written and submitted to congress hoping they'd ram it through like his stimulus bill. What is in there (HR3200) is WHAT he wants...PERIOD! The fact that idiots cannot see what they are reading is a testament to their government school educations and democratic endoctrination as sheeple. Maybe Obama should have labeled his plan Shock and Awe for the aged and infirm. Maybe Operation Enduring Freedom for illegal immigrants and the entitlement minded. In truth Obama's healthcare reform is a tobacco smoke enema for the drowning American taxpayer. All roads lead to socialism with Obama at the wheel. And don't even cry that he won, get over it crap...IF he had ran on a platform calling for socialism he'd have been laughed off the stage. He lied and his agenda is clear. Too bad you (Americans) bought it, shut up, learn your lesson and go on."
Posted by Tujeez on Sun Aug 16, 2009 6:45 AM ; Augusta Chronicle.
Our fellow citizens voted for a Socialist for President, one who is determined to implement his Socialist agenda now, now; do you really think they'll change overnight and help us? There's a bridge for you in New York!!
First you get the money, then you get the power, then you get the girl, ah, well, anyway, gentlemen we all know that congress is liberal controlled, the president is liberal minded, and the media is liberal slanted. The SOLUTION is political.
We make a platform, and then pin-down those congressman and senators who disagree. Then, get the word out--conservative talk radio, FOX, etc, and then
BACK political opponents---and vote these bad folks out. Use your office and
place posters to advertise which politicians we favor (each locally) and which we
don't. Send letters to your newpaper editor. Support your state political action
comittee. Send money to support the physicians already in congress to further
support us. Teddy Kennedy passed---which in terms of health care reform shorts
the bad guys one leader. If the Swine flu hits as hard as has been predicted,
maybe the population at large will view their physicians differently. We must
hang together gentlemen---or we'll surely hang separately.
In 1930's Nazi Germany there was:
Anti-Christian/Anti-God, Anti-Family teachings
nationalized education and health care
suppression of individual rights (anti-gun laws)
disregard to human life (euthanasia, abortion)
anti-morality teachings (the concept that there is no right or wrong except defined by the government)
government defines moral issues rather than religion (gay marriage)
removal of religion as an influence in society
By the early 1940's the German government controlled almost ALL aspects of an individual's life. This is SOCIALISM.which we face!
We need to act like Dr. Sermo Doc 322 says above. You can't wait for "the other guy" to do it for you. We all must act forcefully in whatever way each of us can and now before 50 Democrats in the Senate decide our fate!
My experience is as a family physician who completed a 30 year career as a clinician with the USPHS. My ten assignments were coast to coast with the Indian Health Service, the Coast Guard as a flight Sermo Doc 102, the National Health Service Corps in two rural and one urban sites, and the Bureau of Prisons. In addition I have done numerous short assignments, and humanitarian volunteering around the world.
Based on my experience and observations, the current "health care reform" effort lacks credibility.
Three essential concepts of meaningful reform are tort reform, single payer, and pharmaceutical negotiation to lower prescription cost. That all three are "off the table" by those advocating "reform" is very telling.
I did not vote for President Obama. With his election I admit to having hope for meaningful change at the Capital. Now over six months into his presidency I find the same old spin, Washington "insiders" controlling information to the president, back room deal making, misleading information, grandstanding, secrecy, deception, and duplicity which has wearied me since I became elible to vote some decades ago. Indeed, I have new respect for Mr. Obama's ability to "fake right, break left" honed in his basketball experience. TK
Rogers (R), MI, has put a great video about Health Reform on YouTube.
It is a very clear and strong statement about the problems of Health Reform which we're discussing here.
Please take a few minutes and watch it.
Here's my "two cents" worth from a bit of a different perspective. I did 12 years of residency and fellowship in the US and was in academic practice in cardiac surgery for about 5 more years. Three years ago I gave that up and started working for an NGO and living in a developing country. One of the main things I have learned is really how much money we waste in our system in the US. Obviously we have a much better health care system, with much better results, but at the same time we often waste a lot of money because we (and our patients) want to use all the latest gadgets and treatments often without really paying attention to whether the increased cost brings much or any additional benefit.
An example: here in the developing world we "still" do surgery for PDA ligations. Why? Because device or coil closure is MUCH more expensive, and we can do surgery with great results, through a tiny "bikini" incision and the kid is out of the hospital usually the next day and needs no follow up care after the usual postop surgery visits.
I am not in favor of the current proposal(s) and am completely opposed to "rationing" healthcare, but I do think we need to do an honest assessment of what things cost and put that into the equation of what treatment to recommend. If the patient (for whatever reason) has a preference for a treatment that is significantly more expensive and without demonstrated (medical) benefit, I think the patient should be expected to bear the increased cost (either at the time of treatment or by means of a higher priced insuranc policy), not the taxpayer.
How about a statement that ensures all have EQUAL access to mental health services and we don't have to wait for "phased-in equality" as the recently passed parity legislation allows. Not providing mental health services when it is needed only drives up visits to emergency rooms and primary care offices! With equal access, we could actually begin to destigmatize mental illness and drastically reduce the number of people who end up unable to work because they couldn't or wouldn't get care before problems overwhelmed them completely!
I am all for reforming health care and the health insurance industry. I believe that tort reform and malpractice reform also have to be included in this venture at this time. From the perspective of a Sermo Doc 102, the business of patient care has changed a great deal even over the past five years. In the past, when a primary care physician referrred a patient to see the Sermo Doc 102, the majority of the visit was spent in taking a history and performing a physical examination. Tests were reviewed or scheduled prudently, and then the operation was explained and scheduled. Presently, when a patient arrives at my office, the majority of time is not spent in history and physical since many patients do not want to have any examination on the first visit. They come with lists of questions generated from review of internet medical sites, and have another list of tests they insist on having ordered and completed before they will consider having any examination or discussion of any potential operation to deal with the ailment prompting their referral. At first, this was mainly for only patients with diagnoses such as newly identified cancer. Now, it included patients who come in with uncomplicated issues such as cholelithiasis. Many specialists are pushed to order tests which in the past were only for certain situations for fear of malpractice claims. This pushes the costs higher, but many specialists look at these higher costs as an investment to cover their own backsides if a malpractice claim results in the future. It will be interesting to see where this process takes us.
I'd be so much more encouraged if the 9,000 docs who signed this or the 20K who've signed the open letter all were talking about clearing their schedules for October 1st to attend the Million Med March on the Mall in D.C. If we could have permission to present these tow documents to our legislators I think it would make a tremendous impact.
I agree with it two hundred percent!!! Finally we have a chance to send a very powerful message to lawmakers in Washington who only seem to cater to the giant HMO's and lawyers. They need to be aware that most of us may be requesting unnecessary tests not for the benefit of the patients but for fear of litigation. They need to know that patients are unhappy and disappointed with the fact that they are not able to spend enough time with their physicians due to time constraints. They need to know that patients get hurt when an outside entity, who most of the time is not a physician, makes critical decisions about how care should be delivered to our patients.
riverside medical group, we support, end of life counselling, is better than futile treatment. basic medical care for every body, health care for all children till 12 th grade
1. Tort Reform Remove trial lawyers from Congress in 2010. Indict corrupt Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform: Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers/Employees. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills. Prevent him from superimposiing Medicare Reimbursement onto private Health Insurance CO's (new "Public Option").
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
6. EMR's: Paid by Gov. stimulus plan, not doctors.
Inform your patients who vote by whatever means possible, the media could care less as they love B.O.
Reform is not just limited to Primary Care-responding to one of the comments above. It is all of us. I as a general Sermo Doc 102 am also on the front line of patient care--making critical decisions about testing, need for surgery and rational care. In fact, with the movement of primary care out of the hospital, the amount of 'primary care' in the hospital by myself has never been higher.
We need honest discussion from our President about real reform, its costs and how to control them. I have yet to hear it.
Sign me up...but, add balanced billing-it is the only way to fairly compensate us for our work & keep up with economic changes in medicine and the general economy.
Politics and healthcare don't mix very well, but it would be nice to have at least the appearance of rational decision-making in play at this time. Physicians should have some input into the process that determines their futures. I'll add my name to this simple request for consideration.
The Congressional Budget Office weighed in yesterday on a proposal that the Blue Dogs have pushed to control costs, a new independent commission to oversee payments made by Medicare, the government program for the elderly. The CBO estimated the panel would save $2 billion over 10 years.
If there is to be a new Commission to oversee Medicare payments, it should be PRIVATE and INDEPENDENT of Congress and the W.H. It should have a majority of physicians on it (Primary Care inc. Fam. Med, Surgery, and I.M.) as well as elderly patients, not just Obamacrats.
I think some Docs sign this without their names since they have a job position in the goverment or insurance company and dont want retaliation....again WE... THE PEOPLE need our country BACK.
I have problems with the "Physician's Appeal."
1. It doesn't speak in sufficient detail. For example, how do we get insurance companies out of the medical practice business. Get rid of the insurance "middle man!"
2. Tort reform is important, but reducing costs requires a lot more than malpractice reform. We need to get rid of fee-for-service and physician-owned health care facilities.
3. Signing as "America's Physicians" is misleading. This only represents readers of SERMO.
4. There is no "I vote no" option.
It is great that health care reform has energized this country. But we must not pass a bill for political expediency. The foundation of health care must be rebuilt before any meaningful change can be made.That includes adding significant numbers of quality primary care docs and general Sermo Doc 102s. Our medical schools need not only expansion, but government help to subsidize tuition of those that commit to a primary care career. Without addressing the need for quantity and well as quality trained primary care physicians, ANY reform will lead to rationing and poor quality of care for ALL.
This fight is real and not just about healthcare. Fellow doctors we need to unite at least to stop this juggernaut coming out of Congress. Even if you aren't the political type, wake up before it is too late. Those of you enamored of the government's plan must have slept through 20th century European history class as well as Economics 101. The generation coming out of med school seems robotic, as if these thing don't matter. Prove me wrong and join together to RESIST GOVERNMENT TAKEOVER OF AMERICA>
I signed with my name but am concerned with the lack of an "I disagree" option to demonstrate the denominator. Any action taken without demonstrating unanymity will have significantly less impact on influencing those outside our community.
After perusing the comments briefly, I'm struck by the thought: why don't these lawyer-hating [or is it just legal recourse hating] docs simply run for congress...after all, who is the government, but us, the people of these united states [commonly referred to as "Americans"]?
I surely agree with the need for and positive result of tort reform. Many physicians are so habituated to defensive medicine methods (especially those that are a bit self serving) that potential simplification and savings will take time.
I do not understand the constant railing against CPT coding. My long memory recalls that the old UCR method was fraught with many problems. Don't you think that it is better to have a way to describe services?
FOX News announced today: ("Phishing Suit")
A Doctors group, the Assoc. American Physicians and Sermo Doc 102s, is suing the White House and the Company who sent out phishing emails to people who never signed up for WH emails, never had contact with WH by email, and never requested anything from the WH by email.
There's a big data base out there under control of the WH which can be used later.
How do we create a Lawsuit against The American Trial Lawyers Association ? We must have serious grounds going back decades????
Obama equates AMA with all doctors.
Justin G. Matrisciano MD FACE
Excellent! I am 100% in support of the Physician's Appeal, and have been working to educate family and friends about the pitfalls of HR 3200 as it is currently written.
ok.....just me
but can she get a congressional pen at least?
It is an ABSOLUTE INSULT and slap in the face that he is not even addressing malpractice reform in this process. If there ever was a time to do it, it is now. We all know the trial lawyers are the #2 donators to the Democrats, but the hypocrisy of tying to "reform" medicine without addressing tort reform is off the scale and it's about time someone CALLS his bull$#^$
SIGN ME UP!!!!!!!!!!!!!!!
We need a new association that is in tune with the WORKING/ Practicing docs of this nation.
Secondly all of SERMO community members who are recieving JAMA with out active AMA membership , should stop recieving this publication-- in PROTEST to AMA policies , i am sure they are making more money on Ads- on JAMA , by showing there readers list , which include us
once again...elitist nonsense and elitist garbage
We are not having a national discussion about health care insurance reforms to make physicians happier by reducing insurance hassles and increasing reimbursement. We are trying to address the problem of the uninsured and the excessive cost of insurance which is bankrupting our economy (except for the health care sector, of course).
Unless Sermo can address the key issues in health insurance reform, it will remain a small player in the big picture.
Sermo Doc 25...reality is that your already crappy reimbursement will continue to decrease under Obamacare. "United" usually means that no one gets special treatment and no specialty should be promoted as being better than another; or is primary care the next special interest???
I am also disgusted that our president would demagogue doctors as the enemy
(e.g. ripping out tonsils and cutting off legs just to make a buck).
It seems to me that the American people are finally waking up to what this adminstration wants to do which is to take over every aspect of our lives. The
threat to our health care sytem is the last straw. "I'm mad as hell and I'm not going to take it anymore"...and for speaking up, we are called an angry mob.
God help us...
PS: I have signed my name to the appeal. If the Chicago gang in the White House are upset with me, then perhaps they will force me to retire earlier than planned.
If I had no real fear of malprictice, I'd send ninety percent of my ER patients home and tell them...
"come back tomorrow"
without ordering one damn thing
G,G.G
But what would be the alternative to CPT codes and would physicians get to be involved if this were truly considered?
Also exactly how do you reform insurance companies without starting over and exactly how do you correctly enforce this reform?
Signed proudly with real name
Tom Matlock MD
We must stand firm. Remember It was after medicare was proclaimed in the 70's that the cost of hospitalization started rising and with every JCAHO inspection the cost rises astronomically further. Get the government out of the practice of medicine
If we are really interested in Tort Reform then let's work on outlawing PUNITIVE damages by individuals. Punishment is one thing that belongs to the State and not Vigilantes.
LET'S DO THIS!!!
(BTW, need a link to share this on Facebook! Let's get the word out!)
Sign me on, Dan! *Click* Real name.
Why am I not surprised that the lawyer occupying the White House has no interest in tort reform?
Amazed as well that it took ordinary citizens to put the brakes on this, when those who are supposed to protect our interests (AMA and our senators and representatives) seemingly could not.
Thanks, Dan...
I believe that we should seriously consider billing by time (at least for face-to-face patient encounters / E&M services). Then there is no "fraud" in terms of up-coding or using the wrong E&M code or CPT code.
I agree we need an alternative to the AMA.
I've signed Sermo's declaration because the generally principles expressed therein are generally cogent & in concurrence with my own on the matter of health care reform. My signature does not necessarily indicate, however, unconditional & unqualified concurrence with all of Sermo's or the AMA's specific positions on health care reform.
For example, the Sermo complaint regarding the AMA's retention of its (the AMA's) revenue-earning copyright on the medical dx & tx billing code is somewhat captious in the sense that I personally (&, I think, probably other MDs) would prefer the AMA (with all of its faults) to continue, for the time being, to generate billing codes rather than to have various & sundry suspect non-Gov't entities assume this task, e.g. the trial lawyers, 'consumer' groups, labor unions, media/academia elites or corporate CEOs (whether of the health care industry or not).
To have 'the Gov't' unilaterally set billing codes would be 3/4 of a step away from a fully nationalized & socialized medical care--a favorite of many but an portentous option which should be thoroughly debated & voted upon, in toto, in broad daylite, by the full weight of the constitutionally-ordained political process.
In short, to replace the AMA with anybody else at this time as authors of the CPT (or any alternative to be widely-used med billing code) would be like replacing the Saigon regime with a Viet Cong-sponsored 'coalition government'!
Full disclosure:
1. I am a member of American Psychiatric Association (which may be within the extended membership penumbra of the AMA).
2. The AMA will never represent MDs with the virility needed because the AMA has neither the Mouth of the Trial Lawyers nor the Muscle of the Teamsters!
how will they live if they stop torturing doctors?
I am in
If we fight, we will be heard.\Don't take this fight lying down!!!!
Good luck in the battle for justice!
Love that No.1 is that tort reform will help reduce cost. I truly believe that to be the case.
Sermo Doc 89 is right on that RACs can and will find you at fault no matter how hard you attempt to be accurate in your coding. As I understand it they are paid on a commission per infraction. Talk about a conflict of interest. This does nothing but make physicians less and less likely to see M'care patients.
Interference by insurance companies must stop - most definitely!!! It's a slap in my face after years of medical training and 23 years of experience to have some clerk not even born when I graduated tell me that what I am ordering is not in the patient's best interest.
Agree that if something is not done to correct the inequity that time spent in cognitive treatment is not as valuable as procedural treatment then we will lose the cornerstone of healthcare - the Primary Care Physician.
Sign me up - real name and all.
1. Unnecessary tests and procedures are reduced through tort and malpractice reform
I agree w/ the statement, but there's nothing in any congressional proposal to address it, and I don't think nationwide malpractice reform is doable in the time we have. Conversely, tackling this issue can turn it into a huge red herring to distract physicians from the rest of the bill.
2. Doctors are allowed to spend more time with their patients and less time on paperwork by streamlining billing and making pricing more transparent (create an alternative to CPT codes)
If CPT is tossed out, it is a virtual certainty that ongress will turn to the insurance industry to write its replacement. I"m unhappy with the AMA, but I would like to consider other options before asking congress to emasculate the one physician's group which currently has credibility (i.e. large sums of money) with Congress and recognition by the public.
3. Medical decisions are made by physicians and their patients, not insurance company administrators
This already exists - the insurers claim that they don't make medical decisions - only payment decisions. Technically, they're right. It's the patient's problem if the insurers won't pay, but that doesn't mean the insurer has forbidden them to have the procedure. In practicality there's no difference, but in law there's an enormous difference.
4. Adequate supply of qualified physicians is assured by revising the methods used to calculate reimbursements.
This statement assumes the continuation of the current insurance payment paradigm, which is the central problem in the whole situation. The chief evil of insurance is that it separates the pt from the physician economically. A better solution which could, if addressed properly, obviate the need for statement #3, would be to ask Congress to eliminate employer provided insurance. Mandate insurance purchase by individuals (with vouchers for the poor, and possibly tax breaks based on amounts spent) and also mandate that insurers accept all applicants while limiting the range of charges insurers can apply for the sick vs. the healthy. This meets the universal coverage desire of the democrats, appeals to the Republican's desire for personal responsibility for health care, guarantees the insurers a huge increase in the applicant pool, and protects the ill from unfair treatment by the insurers.
I think I would rather we do nothing than do something which could be counterproductive. The AMA and the professional societies are the only organizations really able to negotiate the SGR - can anyone here claim expertise in all the complexities of the damn thing? Do we really want to cripple the AMA economically in the immediate future? I don't like 'em, but I think they're the best we currently have re: the SGR. If we waste efforts on things like statement #4, then we indirectly indicate our support for the current system in its present form - we're simply another special interest group looking for tweaks around the edges. The basic format is broken, and that's where the change needs to occur.
There perhaps should be a 5th point, in my opinion, about doing something to curtail the outrageous costs that hospital corporate entities subject people to, like when they charge someone thousands of dollars for a CT scan. It's just a stupid game they play to extort money out of insurance companies.. then the ins. co fights back and the patient gets caught in the middle, forcing them to waste their time and effort getting their bills trimmed.. sad..
The AMA is a joke..
This president is a joke along with his entire gang of socialist lap dogs.. I've had it with all of them..
Some entity whether it be govt or insurance companies will attempt to take over this task. Agree with Whatagas on this point. Would love to have the ability set fee for a service now but I dont think that will be realistic right away. So we need to be armed with additional alternatives rather than just saying let's drop CPT codes or let's just set a fee for service. But maybe proposing this now is the way to go and in that case we should be ready to explain why set fees for time or service benefit the entire system and also get patients to understand why this would help everyone.
I would also suggest that the oath mentioned in the last paragraph be more generalized to support the promises we made to our patients in whatever oath we may have taken--I took the oath of Maimonides, not Hippocrates.
You seem to have no trouble making use of his free service to you. If you really mean it, you should "resign" from Sermo as a sign of protest ..... actions speak louder than words. Will wait to see what you do.
Can we fix this??
Can somebody please let Obama and the public know that if preventive diabetic care is so important, why are the PCPs getting a "pittance" why bank CEOs are getting millions?? Anybody talking about a pay raise??
Also, Sermo Doc 102s do not get 50K for an amputation, we get $700 to $1100, then we need to substract 30-50% of overhead, then taxes.
Sermo Doc 32, the answer to your question appears to be the same answer for most of the "evil" in Government in general today....the love of money and the love of power.
Somehow the wrong people were able to take over the runnings of the AMA and have not just sold us out (for money) but are helping to try to sell out the working public as well. Until Sermo I too was ignorant to the amount of money they take from us yearly. If they did not justify their existence their cash cow would die. Sad to learn how much propaganda I accepted without questioning the validity.
Maybe a call for their resignation by a large group of Docs, if it were to hit the news might motivate more people to wake up and learn how they are being lied to. It will never air on Obama Broadcasting Company though.
Robert A. Beltran, M.D., M.B.A.
President, Latino Med Policy Institute
Encouraged to find like minded physicians who give a real damn about the care of patients and our profession.
The Obama attempted hijacking of the health care system will be ruinous to the well being of our patients and destroy the American way of life as we know it if he succeeds.
He has utterly no clue as to the practice of medicine. His recent comments about tonsils and reimbursement were ignorant and disgusting. Totally out of his league and he has the gonads to try and take over our livelihood and lives. Disgraceful and appalling.
Add to it the fact the SOB's in Congress won't even sign up for the trash insurance plans they're foisting on the public and I want to vomit. Hit me with some more Zofran.
The problem is that beyond this forum most of us don't REALLY know what's in the bill and what we are appealing exactly. And that goes for the majority of Americans, including physicians, and probably even the congressmen that are for or against it. I think that's been my biggest problem with Obama's plan is that no one seems to clearly explain what is in the 1100-page document.
I love to be more informed, but who has time to read it?
Tony Trpkovski
Reform STARTS with reform of our problem;
So I AM IN.
SEE IF AMA ORGANISES ANY TOWNHALL MEETING
Agree with Sermo Doc 116. Obama knows little about healthcare and demonstrates this daily. He also recently compared humans to cars when talking about penalizing hospitals and docs for readmissions within 30 days. He said, "They must not have done the job right. If you had to bring your car back within a month for the same problem, would'nt you be upset?" Demonstrates that he has such a superficial understanding of what is really going on. Which is why physicians should be running all of healthcare.
elr
I would really like to see a Federal law that would encompass "loser pays" in malpractice lawsuits. It would stop a lot of these frivolous filings just to try to settle with the insurance co.
Doctors should submit a bill based on the time they spent with the patient plane and simple. If they performed a procdure during the visit then they should bill for the time for that. Payment should be based on a system of numbers based on time increments of 10 minutes. i.e. #1=10 minutes up to a set number say 12= 120 minutes spent with the patient. We should not have to write dx codes for everything. Testing can continue to have it current set of codes without the requirement that the proper diagnose code go along with the test.
There should not be modifiers and irrelevant diagnostic codes.
As a "dread" specialist, I would like to address the primary care docs and tell you WE ARE NOT YOUR ENEMY. The IMs, Peds, Gyns, and FPs save my a** on a regular basis. I just want to practice urology, help my patients, and pay my bills, maybe have a little left over for me.
Tort reform in Texas, Prop 12, has lowered my malpractice premiums significantly. Malpractice attorneys simply don't see profit (winning the legal lottery) in many questionable cases so they don't accept those cases. If patients really have a legitimate concern or complaint, they can go to the Texas State Medical Board. Haven't ever had this happen to me, but from what I understand IT IS HELL.
If I order so-called "unnecessary tests," (usually determined after the fact) it is because I don't want to miss something that could harm my patient, not so much because I am afraid he will sue me.
We CANNOT let insurance companies, Congress, and the President divide and conquer us. ALL physicians need to stand together as advocates for our patients and for our profession. What we do IS noble and a big Sermo Doc 55 on many levels. Just ask our spouses and our kids.
Thank you Dan for providing us a forum to share ideas and to b***h about all of these issues. Keep fighting the fight! Solidarity among physicians!
That would be the only way I would support any of this.
Cognitive doctors should be paid by the minute, just like lawyers.
Procedures should be paid by CPT code, as always.
Count me in using my real name.
No mention of tort reform since the bill was written by trial lawyers, just like Mike Huckabee said Sunday.
Need to get all that out to the public.
fleming.house.gov
Most problems in the healthcare market derives from governmental interference,
including special legislation ( because of lobbying of course) protecting hospitals and insurance companies from competition and transparency, legislation which allows insurance companies to cherry pick their subscribers, and government driven distortions in price for medical goods and services, which the insurance companies and pharma take advantage of.
I am glad to see Sermo making an effort to engage docs in trying to shape their own destinies. The passivity of physicians in the face of dwindling control of their own professional lives has been shameful. We need to stop listening to policy wonks who don't know anything about the day to day practice of clinical medicine and start telling people 2 things 1) Leave us alone to do our jobs properly, and 2) We know more than you will ever know about the reality of delivering healthcare.
The govt's perceived need for reform is almost always supported by arguments that the US ranks low in healthcare and that there is a large number of uninsured (which somehow went from 40 million to 50 million over the summer). This along with the expense of healthcare seems central to the current administration's reasons for writing up a bill - at least that is what we and the general public are supposed to think apparently.
So we should also get the facts out there about life expectancy in the US and how these numbers vary from country to country depending on what types of deaths are included in these numbers (accidents, military deaths, ...). We know the uninsured population is partly made up of illegals, those who can afford it but dont buy it, those who think they are too young and healthy to need it, those who qualify for medicaid but dont apply, etc... The number of people who really NEED help is much less than 50 million. Enough of the lies.
We went from having a career to just having a job- I want my career back. We Sermo Doc 55 too much for too long to be treated like this.
Go get em Sermo. We are here to help.
Michael J Peck MD
An online straw poll on the doctors-only Web site Sermo.com found that 94% of 10,500 physicians polled oppose the bill. While the sample isn't scientific, and may have attracted an anti-AMA crowd, it's gotten attention as a vote of confidence against the group. The head of Sermo, Daniel Palestrant, has been on an anti-AMA rampage all summer, appearing on cable news stations to say that doctors have been sold out. Doctors aren't the reason why costs have risen or people can't find insurance, he argues: "Overall health care spending has gone up while physician salaries have gone down."
Palestrant accuses the AMA of being more concerned with keeping its seat at the White House table so it can protect its various ancillary moneymakers, like its estimated $75 million business licensing procedure codes to HMOs. (The AMA says Palestrant is upset because it ended a partnership deal with Sermo in May. Palestrant says he let the deal expire because the AMA doesn't care about its members.)
Whatever may motivate Palestrant, the anti-AMA bandwagon has picked up speed. Seven state medical associations--including those in New Jersey, Texas and Georgia--took the highly unusual step of breaking with their parent to denounce the bill. Others big ones like Arkansas' have also expressed deep skepticism, without specifically breaking with the AMA.
Several groups of specialty doctors--neuroSermo Doc 102s, plastic Sermo Doc 102s and general Sermo Doc 102s--have joined the anti-ObamaCare coalition and have even been joined by two physicians who recently served as presidents of the AMA.
"The AMA," says Gregory Tarasidis, a head and neck Sermo Doc 102 in Greenwood, S.C. who is currently president of his state medical association, "came out too early and too strong."
Sermo Doc 307 is advised.
Reimbursement for a diagnostic heart catheterization $300-400.
Hospital reimbursement $8000
Malpractice $20-30K
Something does not add up
Add my full name.
And, Lou, Gertie should get more than a pen. Some medal and a title, maybe First Goat
For example, I spend much time on the phone, reviewed lab work and answering questions. And I spend a lot of time with patients in the office.
Maybe the first five minutes of a phone call are not charged...but at least allow us to bill something after that
Billable hours would be a fine replacement for the CPT code system: easy to calculate, familiar form (attorneys and accountants do this), and justifiable. Billing to the patient or insurer should include: time spent directly with patients, time spent on documentation, time spent filling out forms, time spent on prior-auth/pre-certs (billed to the insurance company), phone time, e-mail correspondence, after hours and weekend call, labwork review, time spent on referrals, staff time spent on all the above, and pass-through costs for malpractice insurance.
It makes you realize how underpaid, overworked and underappreciated you are.
I think I spend 80 % of my time involved in defensive medicine. Rushing all day long day after day.
As appealing as tort reform is (and it is vital), I can think of unnumerable plans that would do more harm than good even if they involved tort reform. That is not to say that I absolutely oppose the Co-Op idea. I just need to know more about how it is instituted and administered before I accept it.
Afterall, it would not be the first time this administration has taken a representative group and exaggerated their level of complicity with the plan.
Tort reform will never happen on a national level anyway.
Ergo, we are screwed.
Your point seems to be that those physicians who oppose tort reform, oppose protecting the doctor-patient relationship, oppose medical decisions being made by physicians and patients, and oppose physicians having a voice in medical reform should have an option to vote against these things. This is a petition, not a poll. You vote "no" by not signing it.
Patients see a bill after a clinic visit, hospital stay, procedure, etc, and some of them think it comes directly from the physician. They have no idea how complicated the whole billing process is with insurance companies and how high overhead can be, let alone the meaning of tort reform and how it could improve care.
Cheers for the SERMO onslaught! On with the SERMO bandwagon for the future of medicine in this country!
1.Bring back the system of "the county hospital" run by trainees of all kinds (med studs, residents, student RN's/RT's).
2. Implement NO legal ramifications--equal to the VA system (and these are the folks that fight for our country).
3. Faculty physicians rotate through---I would even volunteer my time for tax credit/deduction and not salary.
4. Missed appts/noncompliance with treatment results in no more access unless paying cash prior to getting further services.
5. implement best practices (no ortho procedures w/o tobacco cessation, weight loss, dietary changes etc.)
Corresponding Benefits:
1. Improve trainee experience
2. mx money saving measures such as cost of malpractice, extra test ordering, etc (ex no CT scan for RLQ pain, anorexia, WBC high)
3. Provides Teaching and mentorship
4. If pts are not motivated to take care of themselves then NO system will benefit them (pts/families have entire medical care covered by SHC and are even given money for food/outings/travel and still people are noncompliant and are "no shows". We do NO good allowing themselves to take such poor care of themselves)
5. same as benefit 4.
Would not be a two-tiered system. I have seen some pathetic trainees and pathetic private physicians. In fact, at a local "world-class" cardiac institue the fellows are much more knowledgeable than the private cards guys by leaps and bounds. All of my care and my family's care done at a training institution...I did not interfere with their training at all.
BTW-in college I ended up in the hospital with rhyabdomyolysis during spring practice for my college sport. Barely survived. Despite gross negligence by our sports MD--I did not seek legal action/compensation for never regaining ability to continue in my college athletic career.
I tried to be brief and look forward to the responses. Please forgive any spelling/grammar errors. Written during lunch break.
3. motivate folks to be compliant and care about their own health
you couldn't be more wrong.
We have a right to protect ourselves from enslavement to our government (employment at a meager salary), and to protect our patients (cost containment and rationing) at THE SAME TIME. It is ridiculous for a FP to say giving more to primary care docs IS the answer. The answers come from limited government waste (usually estimated around 50 cents on the dollar), and increased free market competition, coupled with appropriate regulation).
Sidenote: It has come to my attention recently that a large number of people in the country are actually being paid disability payments from medicare of 500- 900 dollars a month (OF OUR TAX DOLLARS), because there kid has a common illness, like asthma or ADHD. That is on top of the free medication and medical care as well. Many people in America are wanting there kids diagnosed as sick, just so THEY can get another government handout. These parents beg their community "primary care" doctors for the GOLDEN TICKET diagnosis, which pays them 500+ dollars a month until there kids hit 19 years old. To make matters worse, if the kids are older at the time of enrollment in the program, they get "compensated" for all the previous "sick" years, getting checks I have heard as high as 50,000.00. WHAT IS WRONG WITH US AMERICA! We need to have compassion for our fellow americans by helping them see that enslavement to the government just leads to unproductive and meaningless lives.
Sermo Doc 177
Thanks for all of your efforts. As a physician constituency, you provide the nidus to crystallize our sentiments and suggestions. As a large group, we are forceful and influential. Kudos!
John Vander Woude, MD, FACS
Perry C. Rothrock III, MD Memphis TN
They can highlight and speak to some but even within the organizations, each of us knows, there are many different practice settings and challenges beyond our individual knowledge. What is cited in the Sermo appeal is pretty much, however, the common experience of those who are not sheltered by the rare employing entity that passes the pain of the issues to others in the organization. Note, I say rare, because for the most part many of the supporting elements' staff of those employing entities do get overcome and then the problems are further heightened for the physician: disparate supporting elements making disjointed "fixes" that affect physician's clinical focus, efficiency, productivity, and expand liability concerns, to say the least. My experience span federal healthcare, academia, general pediatrics in smaller community setting to subspecialty medical center based care. At this point in my life/professional career I am setting out to do what I feel increasingly strong about---bring subspecialty care closer to the patient community, as much as possible, and the primary care physician --even though I have to do it on my own and out of my own pocket (which is not deep). The counter forces highlighted in this appeal are incredibly daunting, but I am encouraged that, at least in this forum, I have the best chance of being "heard".
1.OBESITY- if we can decrease this in our country think of the possibilities in decreasing money spent on healthcare. LESS HTN, Cardiac comlications, diabetes,amputations,kidney failure etc etc etc etc...... Let's help our primary docs, teachers,media educate our population.
2..TORT reform.
3.Insurance reform.
PHILLIP CHARLES ZINNI III DO,
God Bless you Dan for your leadership, and God Bless and Protect THESE UNITED States.
As for the comment above about good luck in the battle for justice; I hate to disappoint Sermo Doc 85, but we currently live in a country which has no justice. Trust me, I have witnessed our legal system first hand. If we practiced medicine like lawyers practice law, we would all be richer and have more dead patients. Do not forget, both the congress and the senate are comprised of far too many people whose previous careers where as lawyers. We CANNOT let those people make a single decision on healthcare in this country.
PF
Dear Daniel and Sermo Team Members,
To continue building credibility and public understanding in the media world of 90-120 second bites, at every media exposure opportunity I would try to provide a framework for the four prerequisites for TRUE and SUSTAINABLE healthcare reform, as listed above by the Sermo Team, by describing them as:
"Four of several key components of an American legislative and regulatory "private market solution" centered on and driven by empowered consumers, not a massive, tax and debt-based expansion of the existing "government control solution."
Once these two brief and "bright line" descriptive phrases are introduced and understood by the viewers, it would be easier to describe the societal value of implementing the first approach and avoiding the second.
Two short paragraphs can then explain the rationale for choosing the correct option for meaningful healthcare reform.
Implementation of the "private market solution" option has been blocked by America's existing government control solution that is dominated by government and its special interest group lobbyists, private and public health plan monopsonies and monopolies and characterized by unsustainable diagnostic and therapeutic waste and billions more lost annually to criminal fraud and abuse.
Except for the Wyden-Bennett Healthy Americans Act, all of the current draft reform proposals in Congress would produce an exponential and permanent expansion of the existing government-driven, unsustainable system.
America's founders would have appreciated the consequences of enacting the wrong option into federal law:
"To preserve the independence of the people, we must not let our rulers load us with perpetual debt. We must make our election between economy and liberty or profusion and servitude."---Thomas Jefferson.
I am carrying a copy of the appeal to Alabama Senator Spencer Bachus (R) tomorrow morning. He is meeting with a small group of hospital admin and physicians to discuss true reform.
Exactly right. Tort reform as per Texas will not decrease cost of medicine so #1 is a false claim and it starts off this "appeal". Looks like all doctors care about is getting lawyers off their backs. Real "tort reform" is tort elimination, coupled by physician participation in a government run adjudication of health injury claims with NO lawyers involved at all, coupled with a review of ALL health injury claims by the Feds AND the State Medical Board to determine how the practice of medicine can be improved coupled with a promise by physicians to work collaboratively to decrease cost of care by 30% while continuously improving the quality of care as demonstrated, in part, by a progressive improvement in the health injury claims record of a state.
1) a Dr-patient interaction supportive Public Option
2) a Dr-patient interaction supportive AND democratic access system for health care injury claim adjudication that is government run, no-fault and abolishes the tort system as the means of adjudication
3) a Dr-patient interaction supportive physician reimbursement system
4) a Dr-patient interaction supportive medical education system that does not debt load physicians who choose less lucrative primary care careers
5) a Dr-patient interaction supportive co-payment system
6) a Dr-patient interaction supportive EMR / EHR / HIE
7) a Dr-patient interaction supportive outcome assessment and feedback system with the goal of continuous quality improvement and continuous improvement in cost-effective care
So far what I see is talking points that do not separate us from those who are this so eager to pass this bill.
How many of you have reviewed the bill?
I haven't but as of today I am going to give up some my "free time" and reviewed the entire bill.
The site is no longer at my finger tips but I found it and bought the transcript (every page ) for 35.63 bucks.
I agree completely about tort reform. Without it we will always be in a catch-22 mode and no change is possible.
However there is no doubt in my mind that either indifference or greed are the root cause of unnessary tests and treatment. I know I see it everyday.
Where we have failed is in taking an active role in using common sense in treating patients who would be better off in hospice but instead are in ICU's eating thousands of dollars a day.
Either we begin to honor our oath to our patients to first do know harm or someone will take the responsibilty from us.
Enough rhetoric! Read the bill and let's start being our patient's advocates and make sure that our decreasing reimbursements while our abilty to care for patients is being comprimised is no longer acceptable as the status quo.
Remember the Movie Network News?
Well I'm mad as hell and I'm not going to take anymore.
Start writing letters to the local newspapers. Let the folks know what's going on.
I do everyday with my patients while in the office.
Make some noise that will count.
Not just on this site.
Get involved and make a difference.
If no changes are made, we are still stuck with this shitty system.
There is NO WAY our compensation is increasing unless we do something radical.
Thoughts from a totally fed-up booger-picking, ear wax-cleaning doc:
1) Cash only - why the hell are we helping ins companies pay for patients care?
I don't remember going to the grocery store and getting ANY grace
period to pay the bill!
2)Going bare - why the hell are we making defensive ins companies rich with exorbitant premiums and malpractice/personal injury attorneys wealthy by tapping our
policy limits?
3)Let's have a good old-fashioned WILD-CAT STRIKE! If all physicians strike for 3 days and only take care of true emergencies, we can cripple the system and then everybody will start listening to us! anyone in?
Kevin J. Donnelly,M.D.
Tampa, FL
REAL insurance is NOT maintenance coverage... TORT REFORM as legal system merely goes for YOUR broken leg is now not perfect....bad doc!
LET INSURANCE COMPETE IN ALL STATES so as job changes, Insurance can go with YOU... unless you can get bettter after relocated... we do not live in single states anymore. and many states are incapable of building jobs as they tax new jobs out of existence
and competition will bring down costs... IN NY state where they put in community ratings HMO, the cost is 2 1/2 times greater for BLOCKED LIMITED ACCESS insurance in contrast to FLORIDA where PPO insurance with deductible and copay is BETTER insurance and (surprise) works thruout the ENTIRE state!! and not just in 3 counties as in NY state..
UNDERSTAND that the ONLY REASON we are in such a MESS is BECAUSE of GOVERNMENT MEDICINE no longer paying for much and forcing cost onto the PRIVATE SYSTEM..
DEAL with the REAL COSTS OF INCREASED premium : legal abuse, government intrusion and building up of paid czars and workers who do NOTHING TO HELP but constantly put on award banquets to reward themselves for nonproductivity!
I signed....put my name on it!
Real name signed on here.
Tort/malpractice reform
Insurance reform
Patient responsibility and accountability (I know this last one is probably not politically correct, but I really think more needs to be said about it)
Physician and patient driven- not bureaucratic government- medicine
in by going to millionmedmarch.
in by mass mailing to congress.
in by talking to patients & colleagues and trying to get *them* to write/call/agitate.
in, in, in.
way too mad to just vent here.
nothing like a pissed off, menopausal, educated, p.r. mom of 7!!!
Consider inviting your congressperson to your practice, make your voice heard.
Remember, we are one million strong- each of us caring for masses of patients per day. Make your congressman/woman's contact info available in your exam rooms, for patients to take with them. This could generate hundreds of thousands of calls per day from constituents which could actually make a difference. We CAN be heard, it is not too late.
When I review the increments in reimbursement from that insurance as a doctor it ihas been only 10% in the last 7 years. Are there any regulations to that sort of injustice?
If this is to be a true health care reform, it should address all the deficiencies of the system rather than pick and choose the items depending on the political or financial strength of the lobbying group that benefits the specific change.
One significant cost of medicine is Medical Malpractice and TORT reform is NOT being addressed or mentioned. From the cost of malpractice insurance, additional test to cover possible malpractice and the defense of unnecessary claims, the high cost of medical malpractice is borne by all of us except for a few that financially benefit from pursuing unnecessary suit.
True healthcare reform will only succeed if:Â
Unnecessary tests and procedures are reduced through tort reform, malpractice reform and the use of nationally established evidenced-based guidelines for problem management.
Insurance billing is streamlined and simplified to make pricing *completely* transparent to patients and providers.
Medical decisions are made by physicians and patients.
Reimbursements are determined by a fair and objective system which takes into account cognitive skills, procedural skills as well as the time invested in the patient's problems. (This is probably the hardest one to define... what do you charge for and when?)
I seek the elimination of CPT codes completely, elimination of insurance companies, elimination of any sort of socialist health care delivery, elimination of malpractice lawyers, and re-emergence of a capitalist medical practice model where doctors can set reasonable fees to be paid by their patients whether in cash or in chickens (barter). I seek a financial and legal environment in which Physicians can provide true charity care to those in need not by force of law (ie. Medicaid/Medicare/Obamacare), but because the Physician has time and money to provide charity care at his or her discretion.
I treat patients who are covered by Medicare and I have never done so "by force of law".
By the way, "socialized medicine" means the government owns/runs ALL HEALTH CARE which includes hospitals, clinics, surgicenters, labs, etc. and employs the physicians, nurses, therapists everyone directly in providing health care. Having a government run health insurance agency that provides affordable care is not socialism.
dnh002 Infectious Diseases Posted Aug 17, 2009 at 4:05 PM
Sermo Doc 25 - PCPs in all other countries with socialized medicine make even less than American PCPs. In the eastern european block they drive cabs for spending $. - We also have socialized medicine !! which is actually run by private insurance companies dominating the market. Canadian doctors actually make more than the US conterparts, but they do payback more in taxes.
Having a government run health insurance agency that provides affordable care is not socialism. - -thank you for what you said. Do not let the insurance companies discriminate the sick by denieng coverage when they need them most.. We need insurance reform, tort reform and a public option.
Put my name on it. Sermo Doc 227
1. Adequate fees for service established by a physician panel
2. Establishment of Medical Courts. i.e Malpractice cases judged by physicians and physician juries (Peers!!!)
www.nytimes.com
key graph:
"The American Medical Association has long battled Democrats who oppose protecting doctors from malpractice lawsuits. But during a private meeting at the White House last month, association officials said, they found one Democrat willing to entertain the idea: President Obama.
In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials."
Obama put malpractice reform on the table, said "I'll give it to you" and Repubs walked away, more interested in scoring political points than doing what's best for the country, and for doctors. They're more than happy to take your donations promising to do something, but when it's actually offered they walk away (I think they believe if things actually change, the teat will dry up-- there's more money to be made in agitating against the status quo than actually doing something about it). Stop being partisan hacks and recognize when someone really offers to do something to help us.
You don't have a flexible system unless it is run as a market. THere is no innovation unless there is little governmental control.
When did someone offer you a reasonable rate to speak with a patient on the phone, the internet, or simply monitor labs which are important to health.
What? You can't see the forest for the trees? NAAWWH.
Hello to all,
1. I ask that you share this with as many physicians as possible to
get them involved.
2. I also encourage you to share this with everyone to further
educate each one of us to help ensure that any "reform" is actually
worthwhile.
There is a website for physicians that serves as a network for
addressing clinical issues and other healthcare matters. Dr. Daniel
Palestrant who founded the site, as well as many of us member
physicians, are interested in true improvement of the healthcare
system.
There is an appeal for physicians to sign to be more involved in the
plans for healthcare reform in order to achieve a system that allows
for the delivery of quality medical care. I have signed it myself.
To read the appeal go to: www.sermo.com
To learn about sermo go to: www.sermo.com
This appeal does not address the 40-50 million uninsured Americans, many of whom will never be seen as patients because so many of us refuse non-paying or Medicaid patients. I don't see anything suggested here that will affect the 50% of U.S. bankruptcies attributed to health care costs.
The "bullet points" are answering the wrong questions: Why does our "best in the world" country rank so low for longevity, infant mortality, children's health, and overall cost effectiveness? Why does bankruptcy caused by health costs even exist in the richest country in the world? Not because of CPT codes or tort reform. Our entire system of health delivery needs to be examined and compared to those of the industrialized nations which have successful systems. Until we can get beyond our own financial self-interest and our cultural blindness to these facts, real health care reform is but a dream.
I agree completely. The current U.S. insurance "industry" is the equivalent of a giant Ponzi scheme, with political buy-offs and a protection racket built in.
The main beneficiaries of this "industry" are shareholders, corporate officers, and paid off politicians. The patsies in this scheme are the government, private businesses, and employees, who pay and pay and pay for this mess.
Sermo Doc 239, Family Physician
Subspecialist who have dominated our medical societies and special interest groups have fought through the years to keep their reimbursements high while those of us in primary care only receive about 55% of subspecialist income and yet our work is more comprehensive and our overhead at every level is higher.
Individual medical specialist have each fought for their own specialiites and the importance of such and the reimbursement while family physicians have been the most benevolent and only in the past few years have gotten themselves postured in a more aggressively.
I am appealing to the 70-80% of subspecialist on behalf of the 20-30% of those of us primary physicians to value us equally and fight for all MD/DOs board certified to receieve fair and equal reimbursement. Yes, we recognize that your residency training is longer, but you are responsible for much less of the total patient care and if you continue to let primary care die, you life will become immensely more difficult as your patients will be looking to you for their detailed and time consuming questions and coordination of their care and their multifacited primary complaints.
If primary care dies, you subspecialist will be reassigned this duty by society and government and your focused care and outcomes will become less effective and less enjoyable. Such unlike the AMA and its members and the weak representation of primary at that level who had no objection, you can pay now or pay later to save primary care by being willing to have at least a small percent of your procedural reimbursement shifted to your patients family doctor and their medical home. I challenge you to step up to the plate and support all doctors that go through the same medical school that you go through and choose to serve society through the board certification of family mediclne or general internal medicine, even if the residency is shorter, we are still co-laboring with you and working just as hard and our work is KEY to healthcare reform and you being able to continue to be a proceduralist and and "subspecialist". Please reconsider and reach down and fight for us and show our government, health insurances and policy makers you value our services by "tithing" a 10% of your remimbursement back to primary care to help us get on equal footing. Please don't be like everyone else who expects us to "make bricks without staw". Thank you for considering to help. Sermo Doc 241
Signed with real name, of course.
You could have added that the third party payer system is the source of most problems. Only when patients watch and monitor where the money is going will we have true cost savings.
One great solution would be: HSA with basic preventive measures such as Pap, mammography, colonoscopy etc included in plan coverage.
Thank you, keep going
I find your comments exteremely ignorant and degarding to physicians. As an ENT and Head & Neck Sermo Doc 102, I have never decided to remove a child's tonsils for financial reasons. If I was thinking financially I would keep seeing that child in the office every month for tonsil infections and charging $100 per visit till the end of time rather than take out that child's tonsils and hope to get $300 with 3 months postoperative care included. You need to get your facts straight and realize that insurance companies and pharmaceuticals are at the root of your rising healthcare dollars. Once you gain some courage and learn that reform comes with insruance reform, you will make some headway. The public option is not an option in this country just look at the VA system and how incentivized the doctors and nurses are in those settings.
Alen N. Cohen, M.D.
I support the appeal.
docs.google.com
the German system may work well for us, tier costs and services based on expectations and level of prevention desired with krankenkasse, sickness funds, like co-ops, competitive as even soccer clubs have them, and reimburse naturopaths, herbalists and the like.
How's that for a novel idea?
Thank you,
R. Chris Kuhne, M.D.
Ob/Gyn
I agree with Sermo Doc 74--TORT REFORM!
By the way, I hate the term "provider". It denegrates our profession. So, I add my support to the previous additions to the commentary.
Otherwise the general public might continue to support the "propaganda machine." And they will continue to think that the only reasonable way to reduce costs is to reduce physician salaries - I've read this idea multiple times on these sites.
For our own cause, we need to make sure we are addressed properly in interactions. We need to use the same persuasive reasoning that annihilates anyone in the US who calls someone a "Nazi" , "Negro" or "Communist"
Try addressing a letter to a lawyer without that meaningless "Esq"!...
Other areas for remedial physician education:
1) Ask for "NO FAULT INDEMNITY" NOT tort reform. Don't just blurt out media blurbs.
2) Demand that people who work with patients not be identified as Doctor unless they have a formal medical education. This includes optometrists, Pharmacists, PAs, NP and DNPs.
We must not ask for reform effort contributions of everyone else but ourselves. We should be able to provide high quality care, second to none, for less $$$ if we are willing to rework some or our own 'ways and means'. How about we develop a system that promotes "cross training" and "additional educational opportunities" in areas where our basic prior medical training provides appropriate foundations for our learning new things and providing our patients with new care options.....without having to go back and go through a second residency? Cut out the turf walls where they are medically unnecessary and are merely business walls. See...I told you, many are not willing to consider this "inside the system of medicine" change. It would promote competition that many do not wish to have. We protect our own turf / system...and ask every other component to consider real change...so that costs can come down, but care can remain superb.
We should, at the very least, consider these changes together.
Tort reform will bring down by decreasing the cost by 30% atleast!
Insurance Reform consisting of
No exclusion for pre-existing conditions
Limitations on out-of-pocket expenses
No lifetime or annual caps on benefits
Eliminate Co-pays for preventative care
No loss of insured status due to occurence of a disease.
They stated a clear and specific desire to eliminate the fee for service model and pursue a Global Payment system nationally.
There was no mention whatsoever of tort reform until a specific question was asked about Obama's amputation quote, which they did not disavow. They see lawsuits and defensive medicine as quality issues, because clearly if doctors just used best practices and bring up the quality, lawsuits wouldn't be a problem. They are opposed to caps, and made no mention of review panels or expert certification.
There was no mention whatsoever of a public option.
End of life care issues are likely going to be deferred to later legislation, perhaps after more conferences
If the pt had to pay a portion, and had individual policies rather than employer purchased ones, a competitive market for such policies would develop. Same way with meds--without adequate numbers of patients willing to pay a designated price, the company cannnot sell its wonder drug prices would come down. (of course on pharma's side, we'd have to lengthen the patent time or have it run from the time it hit the market, not years before). I'm happy to sign the document. It's good to have a DOCTOR forum. I liked DR. Tofflet's post especially . Marilyn Janke MD
How does one remove the insurance functionary from decision-making while also expecting a third party to pay? If this happens, premiums will assuredly skyrocket, unless intelligent insurance reform takes place. How is this to be done?
Are pre-existing condition exclusions to be outlawed? If so, are healthy people to be required to buy insurance? How much insurance? Will this work? I'd like to hear from an expert on insurance what would be required from the healthy populace to make this work.
"Revising methods to calculate reimbursements": there's nothing specific in this to help those of us who are nearly out of business, i.e., E&M physicians. This is why the AMA has been useless for E&M physicians. They are too scared of their procedural members to advocate for E&M practitioners in any meaningful way. Does it mean pay E&M more? Or does it mean pay everybody more? Nobody will listen to that.
.
Rx for Health Reform
START OVER PLAN:
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Indict corrupt Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition! Allow interstate sale of health insurance with more competition, lower premiums, portable policies, and better deals for docs.
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills.
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
6. Don't fall for Obama's Global Reimbursement Plan for private Insurance. It's just shifting Medicare Reimbursement to private co's, a modified Public Option. Other ammendments will cover emploers' HSA's, rationing of high paid procedures and other care, and death Panels.
Inform your patients who vote, the media could care less as they love B.O. who seems to be much slicker in modifying his Public Option.
Will Doctors Opt Out Of A Public Option?
________________________________________
Date: 2009-08-26, 7:10PM PDT Craiglist
Reply to: comm-ucahn-1344356949@craigslist.org [Errors when replying to ads?]
________________________________________
It appears at least some plan too. Dr. Alfred Bonati, who heads the American Society of Medical Doctors, says he plans to say "no" to accepting patients under a government run plan and, according to a poll he cites, so do an awful lot of other physicians:
Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.
Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient's family.
I share the view of the 60 percent in the August poll -- those doctors who are planning to "just say no" if government-run health coverage is implemented. Many of us already do not accept patients who are on Medicare or Medicaid because of restrictions those programs put on our decisions as doctors. It pains us to turn away a patient in need, but the narrow rules of government reimbursement programs stymie our ability to follow our oath, so we simply opt out and work with patients who are also in need but have more flexible, private coverage.
If a government option gains the popularity that is expected -- after all, who would not choose the most affordable option available, and how could any option compete with one that is subsidized by taxpayers -- millions of Americans will face severely limited options in choosing a doctor. As physicians reject working with a system that does not honor our oath, patients will be left opening their own checkbooks, or going into credit card debt, to get the treatment they need and deserve.
The law of unintended consequences again raises its head. The government may indeed put a public option in place - whether or not the citizens of the nation want it or not. And they may, through legislation, force insurance companies to take everyone without exception, but -at least not at this point- they can't force doctors to accept patients under plans that don't feel reimburses at a rate commensurate with the care given or doesn't allow them to treat a patient in accordance with the oath they took.
Of course that then leaves that system with a problem and the government with a dilemma - does it then force MDs to take anyone who applies (as it will insurance companies) regardless of insurance plan? And if so, how do you suppose doctors and other health care providers will react?
It is these sorts of problems, dilemmas and unintended consequences that few are talking about in this great "debate". What if it is doctors who become the Atlas that shrugs when all is said and done? What options would the government then have - in this land of the "free" and home of the brave?
He wants to cut salary of physians but what about hospitals charge10-20 times for the procedure & what about insurance companies pay providers less & has very high health insurance premiums. Insurance comapnies are allowed to make money but providers should not.
Medicare & Social Security needs bail out, not car makers & not financial institutions..
Need I say more?
GET OUT OF THIRD PARTY CONTRACTS AND PRACTICE MEDICINE!
Obamacare ?
Let me get this straight.
Obama's health care plan will be written by a committee whose head says he doesn't understand it, passed by a Congress that hasn't read it and whose members will be exempt from it, signed by a president who smokes, funded by a treasury chief who did not pay his taxes, overseen by a Sermo Doc 102 general who is obese, mostly unConstitutional, and financed by a country that is broke.
What could possibly go wrong?
Per Anon. 8/20/09
To my regret we haven't discussed medical education reform. I don't have anything original to add; most of what I believe should change has been suggested by experts. Everything we needed from calculus, physics, organic chemistry, and inorganic chemistry could be taught in six weeks without making it a weedout program. Everything we needed from biology could be taught in six weeks or less and incorporated into microbiology. Anatomy, physiology, biochemistry, economics, statistics, pharmacology, microbiology, biochemistry would be the new premed sequence (optional: a year of law), reducing med school to two clinical years.
We'd get out two years earlier and two years less in debt and we'd be better educated as docs. And we could have more doctors.
I would assert we would have more caring doctors as well.
We all know what it's like, but does the President or the public? If I submit a fee schedule to a company, and they agree to pay what I'm asking, I know I'm not asking enough. So, I raise my fees to the point that the companies don't pay me what I ask, and then I know I've done my best. Sadly, I then have to stick by my inflated fees with my self-pay patients or be guilty of insurance fraud. Meanwhile, the big practice down the street may be getting 15% more than I for the same service from the same company. And of course, I can't ask them what they get, because that's a violation of my contract with them. RIDICULOUS. And, I won't know what I'll really get paid until AFTER I've signed a contract. How crazy is this?
Eliminate employer provided insurance. Require everyone to purchase private insurance (like auto liability) and require insurers to accept all applicants. Require patients to pay for care and then seek reimbursement from insurers.
Admin and high demand are the primary drivers of increasing medical costs. Doing these things eliminates administrative costs (insurers will compete on efficiency and service, not denials and payment reductions, and providers can reduce staff substantially), and reduces demand (patients will think twice before opening their own wallets; doctors will no longer have incentives to overtreat for profit.)
There are a ton of details, but unless the basic paradigm is changed, nothing in the congressional proposals will rein in those two basic cost drivers.
I am a Sermo Doc 408 general and vascular surgeon (osteoarthritis and bionic below the waist). Living near the Onondaga Nation Reservation, and having had a good number of Onondagas in my practice I went to the health center which is quite a nice facility to see if I could help out. I knew the medical director and she was enthusiastic, after all, a free surgical service in an underserved population wasn't a bad deal. Unfortunately, the clinic is managed by a "community health center" who are government funded and are reimbursed on a "per diem" basis. I was able to work two days a week, but my offer was turned down. the reason? I couldn't generate enough income on a per diem basis to cover the cost of malpractice insurance. Even a minor surgical procedure is reimbursed the same amount as a 10" script renewal. I guess I could pay the community health center the difference to care for some needy patients but I think I'll pass on that for now and wait for this different type of "fee for service" (doctor pays government to treat his patients) practice to be legislated into existence. It isn't that far off reality.
I would like to hear why the health care community and those interested have not discussed a return to a straight fee for service practice with government catostrophic insurance. Get rid of the middle men and women, the fancy high rise buildings and millions of computers. Let doctors run medicine. Forty years of taking physicians out of the "provider"-patient relationship hasn't worked. Aphorisms say it all. 40 years ago, "if it works, don't fix it" They fixed it and now it doesn't work; and now "if it doesn't work, fix it". They won't fix it because of the embedded, self interested insurance infrastructure. I'm going back into practice as a micropractice and make my fee for my service work for my patients in my community.
Over the past nine years I have been trying to make people laugh with my publications (Placebo Journal and Placebo Gazette). The stories and parodies illustrate much of the absurdity in our healthcare system. Right now healthcare reform is all the rage and I fear that when it is all said and done (after the politicians make their backroom deals with the special interest groups) that patients will be left out of that final conversation. Please help me to remind the politicians not to leave the patients behind! We have created a song and accompanying video that illustrates this concern. It is not one of our humorous pieces. This one is serious. This song and video are NEITHER LIBERAL NOR CONSERVATIVE! There is no personal agenda here. You can download the song by going to the home page of our website www.placebojournal.com. Look for image with the patient facing Capitol Hill and follow the simple directions or...
If you want to directly download the song from this post:
www.placebojournal....
The lyrics are here:
www.placebojournal....
You can also see the video at multiple locations:
YouTube
BlipTv
Metacafe
It is important to remember that we are all patients (I have had 6 knee surgeries, Grave's Disease, and malignant melanoma). Let's show the world we have a voice.
Sincerely,
Douglas Farrago MD
Editor and Founder
Placebo Journal
Obama Health Czar: Any Czar appointment by Obama effectively bypasses Congress or any other oversight and leaves decision-making and operational decisions in the hands of Barack Obama through 'Executive Orders', which is the primary reason for Czar appointments. There is 'Nothing New' under the Sun and this approach was used about 70 years ago in Germany. This approach is basically a 'Hierarchical' structure where someone is appointed directly and has the sole responsibility of oversight of a particular function i.e. 'Detroit Czar', with little interaction with anyone other than Barack Obama.
Torts, Insurance and HSA's: We need urgent Tort Reform. Investigate the Trial Lawyers PAC Lobby and how much they pay Congress to support them. Indict the crooks and remove Sen. Specter (PA) in 2010, the worst of the bunch. Indict the corrupt politicians surrounding B.O.!
Have the Justice Dept. investigate the largest Health Insurance Cos., remove their ANTI-TRUST EXEMPTION, and break them up like AT&T. Many smaller cos. can compete effectively in a free market and work with us fairly. Allow insurance policies to be sold interstate to provide more competitive pricing and better negotiations with us.
The HSA is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all team members who work 30 hours or more per week (about 89% of all team members) for a high-deductible health-insurance plan. They also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness. Their employees love the Plan! Even Obama, Pelosi, Reid, et al, could have an HSA! Let insurance companies sell health-care policies across state lines.
Interstate Insurance: This excellent idea has been before Congress since at least 2005, when Rep. John Shadegg of Arizona proposed it. Why not remove the restriction which now says that if I live in Washington, D.C. I've got to buy a D.C. health plan. Instead create a national market for health insurance, so if there's a cheaper plan in Pennsylvania, you could buy it in Pennsylvania?"
Interstate competition made the U.S. one of the world's most efficient, consumer driven markets. But health insurance is a glaring exception, esp. since it has an ANTI-TRUST EXEMPTION. When the competition caucus in Team Obama has to look for Plan B, this is it.
Stop Obama's plan to create a Universal Global Reimbursement Plan for Private Insurance! This is just a modified Public Option Plan to blame Insurance Co's and suck us into another B.O. Plan!
You know, there are other countries where physicians don't even need to hire anone to do the billing; they just fill out a simple form electronically just as they do an H&P or a progress note, hit send, and promptly get the reimbursement.
And, since I was led to this site by a 'tell us your insurance company horror story' teaser, let me just say this magic moment in my life: Getting on the phone and arguing with some insurance company dweeb about coverage for my patient, injured in an auto accident, to prove that this was not a 'pre-existing condition'. Somehow I think many of my colleagues have similar stories
A.J.Stankiewicz, MD, PhD
A situation that I ran into two years ago at a Florida hospital while working on a telemedicine venture tells it all. The company that I was working with provided telestroke services for hospitals that did not have neurologists available to treat acute ischemic stroke with TPA (stroke outcomes are often much improved if the stroke patient is treated with TPA within 3 hours of the stroke). The problem -TPA can be a risky treatment, as it can cause bleeding and death in a small percentage of patients. We provided (I am no longer involved with the company) stroke specialists to give this treatment to qualified stroke victims via telemedicine. Of note, this hospital had 11 neurologists in a group practice right across the street. Because the treatment is malpractice risky and the reimbursement rate is so low for the time involved (a neurologist would have to leave his/her office for 2-3 hours to treat a stroke victim with TPA and for this receive less than $200 in reimbursement - a neurologist could easily generate $1200 during that time in the office), the 11-neurologist group refused to do ER or stroke coverage. The neurologist would lose money and could get sued for millions of dollars -- who would want to do that??!! I never thought I would see the day when physicians would be so disgusted with the health care system that they would turn their backs on patients in distress, but I can't really blame them.
Signed: Eduardo Ibarguen-Secchia, MD
Patients come into the office stating they have 'full insurance'. They discover only then all the exceptions and limitations. This is especially true in psychiatry which has limited coverage thanks to the influence of HMOs and PPOs and the social disapproval.
Medicare also gives the impression that it is full insurance. It has too many exceptions, such as optical. It also has a fee schedule that barely meets overhead in metropolitan areas. Ted Kennedy blamed hospitals and doctors fees for the cost of medical care. He never looked at the for profit insurers, or the pharmaceutical 'industry', or the corn producers that encourage fattening foods and are SUBSIDIZED to produce more, etc... Even with the government option, costs will be a problem since there will have to be a LARGE number of new doctors, and their incomes, and additional facilities as well as...
Then there is the question of adequate funding to avoid the debacle of Canada, or the problems of the UK. Medicare is a good example of inadequate funding. Politicians are notoriously unsympathetic to incomes other than their own, especially when they can blame others.
A national health service can solve many problems, but inevitably will generate its own. They are likely to be less of a problem for the citizens\people than what we currently have.
Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.
Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient's family.
Leave it all for the NP's and PA's...LOL !!
Dr. Rohack,
I am reading your article in American Medical News and all I can think is that while sitting at the table with all of the politicians, YOU have become just like them. In your article you include a few words that make doctors think you are on their side, "including pushing for liability reform", but most of your words sound exactly like the politicians. I am sure that the membership in the AMA is suffering as a consequence of your position in the current healthcare debate, and appropriately so. I am a cardiologist, like yourself, and practice in Miami, FL. As you probably know, we have the highest malpractice rates in the country. No one dies in Miami-Dade county without a lawyer being called. We also have one of the highest cost/medicare patient. The reason is clear to anyone practicing here, defensive medicine. Sometimes the degree of defensive medicine we see is shocking. Like a patient who I saw in the office a few weeks ago who was seeing me because surgery to fix her BROKEN ARM was delayed by over a month as people were concerned about the risk of the operation. This was a fairly healthy 60'ish woman, who obviously did fine. It is hard to believe what medicine has turned into in our area. But I can assure you that no one in this chain was delaying her to make extra money, it is just plain fear (of lawsuits)!
My point here is that your balanced article is not really representing doctors in Miami-Dade county. If you were representing us, you would be at the table saying if liability reform is not being discussed, we will not sit at the table, period!! The debate that you are having with these politicians is intellectually dishonest. You are telling the American people that you are trying to put together the best plan for them. The truth is that they have essentially taken liability reform off the table, but you continue sitting there telling yourself that you are helping by debating the other important issues. For doctors in Miami-Dade county, and for many across the country that is a joke! The fact that the President used you as a pawn, by telling the American people that doctors were behind HR 3200 because you were "at the table", makes YOU (the AMA) a joke.
Dean Heller, MD
I am a physician with the long white coat, long hours and loads of face time with patients and families in critical parts of their lives, though I make 40k a year and carry three times that in debt I put off as long as I can. I have 2 young children who have no idea why I am I am never home and dont understand that I have to moonlight just to pay my bills and keep food on the table. Dispite this, I am still a "physician" who needs a paycut to pay for a broken healthcare system. Unfortunately physicians have yearly taken paycuts and cuts in reimbursement dispite yearly increases, or COLA, in every other field, from lawyer to laborer. By the time I actually apply for a job I will have 7 years of education after my college education and if I went into business or law I would be sitting on a board, or be partner, either way clearing high six to low seven figures without question, but my future salary is now in jeopardy.
We have redundancy in our system which add costs and is hindered by poor information systems. Our tertiary care hospitals absorb the costs of these and those unable to pay and have to raise costs just to stay open. Our basic costs are driven up by factors that if fixed could reduce healthcare costs more than any provider pay cut.
Much like any market driven industry, healthcare providers need security if we are to continue to complete 3 to often times 10 years post undergraduate education at 40k a year just to care for other people in our community. If lawmakers would like to make it less an incentive for the smartest in our culture to persue healthcare, I would urge you to think about who you would like to operate on the brain of your 3 year old if he develops an unexpected cancer, or to be threading a wire and ballon into the heart of your parent as they enter cardiac arrest with 2 minutes to survive.
I am a cost to the heathcare system, I would love to minimize it by fixing broken systems, but I will not Sermo Doc 55 the care of my patient and your loved one and I hope that I am not sacrified in the process.
10 things to think about this week:
1. What exactly are "middleman" insurance companies doing that warrant them taking up to 15% of your healthcare dollars? That'd be NOTHING!....REGULATE THEIR PROFITS....(oh...that'd mean reforming Government...eliminating lobbyists and special interests...and then our "Representatives" could only get an occasional lunch instead of pens and sticky notes! (gasp!)...OH...THE HUMANITY!)
2. When did my services as a Physician become the intellectual property of the U.S. Government? What if they gave a "plan" and no Doctors came!
3. Why did I have to trade both of my own kidney's for an MRI for a patient last week?...having to explain Sudden Sensorineural Hearing Loss to an Insurance Company "goon" who, never having heard of the condition, had the ability to deny the study to the patient? NO ANSWER?
4. Why doesn't the President of the United States know that in NJ, you are likely to get more $$$ by seeing a child twice in the office, than by taking out his/her tonsils? UNINFORMED! $202.50 for some of these big ticket cases...no risk/no down side, right?
5. Can someone tell the Congress and the public that the Brinks Truck doesn't stop at my office anymore!
6. Confession of the week: A patient ratted on another patient this week ... (is that a HIPAA violation?)...told me her friend was having ear problems and had been laid off...and was skittish about calling the office due to her lack of funds...I had the staff call her and bring her in THAT DAY...charged her $0.00....she said "THANK YOU!"...that was more than adequate payment...don't hear it enough since we all became "public enemies". If the media wants to know why a professional would do such a thing?...the answer is "Because I can!".
7. There seems to be a problem with various Insurers receiving requests for studies, despite our sending or faxing them to the correct place. I propose that all communications be sent to the same address that patients send their premiums...they never, ever, don't arrive at that address.
8. If I had time to figure out which Insurance carrier prefers which medication, I'd also have time to travel to Mars and back this week. Here's how it should work: I write the script for the med I prefer...the pharmacy dickers with the insurer as to the appropriate or "recommended" substitution...not my problem...nor should it be my problem if there are complications due to their mandated substitution.
9. I practiced 25 years with narry an error related to my written prescriptions. I'm using the newly mandated E-Rx system for 6 months now...3 errors so far...and one week of constant callbacks due to non-received Rx's. Come clean...this is not meant to reduce errors...it's to track and eventually ration Rx meds.
10. Wanna save money?....Cut waste and abuse. My Dad, may he rest in peace, had enough diabetic supplies for the entire state of New Jersey!...and received them for months after he passed. They called regularly and "coaxed" him into "needing" more, and more, and more! (Our greatest generation does have trouble turning down free stuff!...It's "unAmerican!") Who's watching the durable medical goods henhouse?
Need I continue?....Tort reform, fair reimbursement, buried in paper (soon to buried in paperless paper), I forgot my referral, and do you really collect those copays? (you cheap and heartless bastard!).
Is there anybody out there?
I was not able to find an open residency position in anesthesia, so I'm currently taking a year off...I obtained a medical license with no problem, but have been completely unable to find employment as a moonlighter or even a general practitioner, or in fact any employment other than part-time work for a "pain center" in Philadelphia.
Even though I'm not technically working as a general practitioner, I have been unable to find malpractice insurance (claims-made policy) for less than $25,000 for two years of coverage as a part-time GP, tail included. I therefore will have to work either as a waitress or perhaps in a grocery store like Trader Joe's in order to pay my malpractice premiums, not to mention my own health insurance costs ($95/month for what is basically catastrophic coverage only).
I've applied for numerous research coordinator positions, but because I'm overqualified, I have not been hired. I don't care about making a good living; I just want to be able to pay my bills without running a deficit at the end of the month.
I recognize, of course, that many other physicians have it much worse than I do, not to mention the millions of uninsured patients who do not seek medical attention until they are literally dying - but at the same time, I never thought that I would have a problem paying my bills during a year off during residency. Without meaningful tort reform, there is no way to really reform the health care system in this country.
Dear Sir,
The Health Insurance Reform bills working their way through the Senate and the House need to be stopped. As a physician and parent, I fear for my ability to continue in the practice of medicine under the oppressive and intrusive legislation working its way through Congress. No matter what name you call it, this will become Socialized medicine with control of health care decisions removed from the doctor-patient relationship and placed into the hands of a bureaucratic panel with a mandate to cut costs not save lives. As a parent, I fear for my children and the mountainous debt they are being saddled with by Congress and the President (before the one to two trillion of Health Care Reform costs). How can you go along with this reckless spending of money we do not have? How can you consent to the policy of printing trillions of new debt to fund Stimulus, Omnibus and the President's budget? FDR proved that spending does not get you out of economic crisis: why do we not take lessons from history.
As a 53-year-old cardiovascular anesthesiologist practicing in Honolulu, I sometimes work 80-120 hours a week, day and night, to the point of exhaustion. I am a vanishing species; no other physicians (anesthesiologists) are willing to subject themselves to the rigors and demands of cardiovascular anesthesiology. There are fewer than twenty-five (25) of us left on Oahu. The Health Care Reform bills as being considered would drive more of us (CV anesthesiologists) to other states with better reimbursement and more physicians willing to subject themselves to the work.
I beg you to reconsider your support for the President's radical policies and consider the long-term consequences of continuing to spend money we do not have thus, the taxes that will be necessary to pay for this spending. I ask you to oppose the concept of Health Care reform that moves us to a Socialist form of Health Care: think of the failures of Keki Care, Massachusetts Health Care, the Indian Health Services, Canada the UK. 85% of Americans are happy with their health care. Please do not destroy the whole system to try to cover the uninsured.
Respectfully, some health care suggestions:
First, fix (the under funded) Medicare and Medicaid programs.
Second, allow health insurance companies to compete with each other across state lines.
Third, expand the number of physicians before you try to cover 40-50 million new patients.
Fourth, provide for adequate reimbursement for physicians so that the brightest and best continue to want to go to medical school.
Sir, please reverse the reckless spending and printing of money stealing prosperity from our children.
Thank you for your time and please fight against the destruction of our health care system because no physician will work as hard as I do now under a Socialist system.
Mahalo,
John M Hunter, MD
TOP MEDICARE LAWYERS OF NATIONAL PROMINENCE will tell you that physicians have almost no true rights of redress under this system, and will be forced to spend less time with their patients. The AdvanceMed Corporation is conducting these Prepayment Reviews in North Carolina, and apparently will continue to do so, despite being the subject of a scathing draft OIG report last year as noted in a front page article of the New York Times, 8/21/08: "Report Rejects Medicare's Boast..." wherein it was reported that "Senator Grassley said Congress might push for an investigation into the private company that was hired to fulfill Medicare's auditing program, the AdvanceMed Corporation", that still rakes in many millions of dollars a year despite Pete Stark's quoted opinion that "this agency is incompetent", and as the article notes, they don't hesitate to "cook the books" in order to "to look better to the public".
Read about Dr. Smith's woeful experience in Family Practice News of 7/15/08, where the AdvanceMed Corporation was noted to be off in their reckoning of the Medicare portion of her practice by nearly 2,000 of the 2935 patients that they would have preferred to unscientifically extrapolate their results to include, and the "guilty until proven innocent" mentality that she endured. Her testimony before the House Committee on Small Business, chaired by Rep. Charles Gonzalez (D-Texas), did not change the incentives built into the RAC system to reap windfall incentives by determining that "medical necessity" was not met, in the absence of any medical director to review or substantiate these findings until the program is made permanent in 2010.
"Dr. William A. Dolan, a member of the American Medical Association board of
trustees, also testified before the committee: 'The best way to reduce common
billing and coding mistakes is through targeted education and outreach, rather than
onerous audits performed by outside contractors provided with incentives to deny
claims,' he wrote in his testimony. One of the greatest problems is RAC's ability to designate improper payments based on contractors' judgment of 'medical
necessity....We do not think that these reviews are appropriate for the RAC program and believe that they exceed the authority imparted to the RAC by Congress. These reviews should be conducted by clinicians with relevant experience and expertise,' testified Dr. Michael Schweitz," notes Family Practice News.
Another physician in Florida went into such debt enduring a similar Prepayment Review with a heavy load of Medicare patients in her practice that before the year was out she and her family were literally homeless, and on the streets.
HOW MANY new patients do you want to accept into your practice next year under these conditions of RAC audit? HOW MANY of your current Medicare patients can you continue to serve when you can be subject to Pre and Post Payment Review for the current pittance Primary Care physicians are receiving to keep saving the Medicare program millions of dollars a year? HOW MANY of your pleas to Congressmen and Congresswomen will be answered with the due diligence that these physicians have so far been denied? HOW MANY Congressmen have even read the new legislation they are proposing, or the old legislation that is responsible for the travesties described above?
IT'S YOUR CALL NOW...Feel free to post these comments wherever they need to be heard.
The reform being discussed by the Obama Administration absolutely will NOT work in our individualistic society (that is if you want to maintain the quality of care we have now). Americans do not want to change their lifestyles. Until then, healthcare will not work. Obama's interest in psychoeconomics: the psychology behind individual decisions(and decisions usually not in the best interest of that individual) and how it impacts the economy (in this case: healthcare), should lead him to the same conclusions. That doesn't seem to be the case. You have to incentivize individuals to stay healthy...and also probably penalize the unhealthy lifestyles. We do this in any other form of insurance, yet it is 'prejudicial' in healthcare.
We had Cash for Clunkers, a widely popular program willing to shell out Billions to individuals to purchase barely more environmentally friendly (healthy) vehicles....all in an effort to make some of us more green, and to boost an industry that has kept us dependent on foreign oil and slowed our progression to a more green economy. Imagine if we did this for healthcare. Pay people to be healthy, maintain health, and prevent the decline in their health. What a concept. 'Cash for Junk in the Trunk' is what I'd call it. Imagine if we paid 1000 dollars for every ten pounds people could lose. I would have patients lining up in my office trying to lose weight! And....many of them would shed alot of pounds...thereby lowering their blood sugar, blood pressure, reducing their risks of heart disease, cancer, dementia, arthritis, etc, etc, etc. They would exercise, change their diet, and our economic savings would be astronomical in healthcare cost recution and increased job productivity. Study after study after study show the savings in healthcare expenditures with reduction of weight, blood pressure, blood sugar, etc. Many studies repeatedly demonstrate that almost 85% of healthcare costs are due to lifestyle choices. How does lowering reimbursement, paying physicians less, and 'expanding' healthcare or making it free (or taxing the rich to fund all this) address or incentivize individuals to change their lifestyles? I have yet to hear the politicians, Obama, CNN, or anyone else address any of this. I've heard alot about pay-for-performance and I've sadly seen this slowly leaking into how physicians are paid.-An insane tactic to not pay physicians when their patient's medical problems are not controlled. How is this the physician's fault? I don't get this concept. All that will do is lead to is noncompliant patients NOT being able to find a physician to take care of them/ patients being fired from practices left and right.
I support the Dr. Vance Harris post. I support Sermo and all the physicians speaking out on healthcare reform. I support the Physician's Appeal and signed it with my name, and I support 'Cash for Junk In The Trunk'....the biggest bang for the buck in reducing healthcare costs.
I am a clinical neuroSermo Doc 102, in active practice, and graduated from medical school in 1968. I have practiced in the military, in an academic setting, and in private practice, and by this time have seen about everything. I have also watched the inexorable deterioration in the physicians ability to care for his patient over the years. In the early 1970's I heard the phrase over and over again "healthcare is too important to be left to the doctors." Well, we now have in the hands of politicians, lawyers, and business administrators, and I don't think we're any better off. In fact, every time any one of these entities meddles further, things get worse, and today healthcare is probably the most restrictive industry we have, and patients have not benefited from this. So, I am happy to see this amount of public involvement.
It certainly is time for a change, but not the change envisioned by our legislators. Had I made it to the meeting, one of the things I would have asked about is the proposed "single-payer program," I believe a disingenuous proposal. The fact is medicine has always been a single-payer program, and that payer is you, dear reader, the patient (read "taxpayer," if you wish). What is really happening is that there is now a great debate going on as to who gets to be the intermediary, the entity that controls the flow of money between the recipient and payer (you) and the provider (me, or a hospital or other such facility). Up to this time the intermediary has evolved into either the government or an insurance company or similar entity. The government, especially the government we seem to have voted into power this cycle, seems the more ominous of the two, because in assuming this power the government is edging toward defining life itself, which it clearly is already in the process of attempting. Personally, I think this is dangerous, but that in no way exonerates insurance companies or other such entities. As the alternative intermediary, the insurer is simply the lesser of two evils, and that includes all kinds of insurance, even malpractice insurance, also known to us as "the lawyer magnet," a closely related issue receiving scant attention in the most prominent proposals.
But the real question to the American public is and should be "why do we need an intermediary at all?" We were doing quite well before the introduction of third-party payers. And, we have always had charitable institutions, as we still do, to take care of those who could not afford to pay. The word "charity," however, is unpalatable to some, and so we use the word "entitlement," engendering a remedial program, and of course once again we have burgeoning intermediaries to administer such programs.
I hope we as citizens have come to recognize finally that all of these intermediaries are siphoning off too much of the money and more importantly at a deeper level, too much of the power. It is time to ask, critically, if they were ever needed in the first place. The introduction of third parties into medicine was not the answer. Now, it is the problem.
as the core cause for health care implosion. Frankly, the AMA has been selling us out for years, and with a liberal controlled Senate and House, we are SURE to get the short end of the stick, and soon. Be prepared to organize into groups, and drop health care plans and insurances for fee-for-service; or, accept patients who's time to treat does not cover the cost of your overhead expenses. Is anyone else tired of working 50% more hours than they did 18 years ago, and being reimbursed now only 50% of what we were reimbursed then? Maybe there's more nobility than I thought in being a plumber---at least some people appreciate their services more than mine. You see, that's because health care is now a RIGHT, and doctors are no longer doctors, but health care providers.
Respectfully,
Leadership of "D4PC"
Insurance companies exclusions from anti-trust
Medicare and unrealistic reimbursement formulas
EMTALA federal laws mandating unfunded care via ERs
HCQIA federal laws providing legal immunity
FDA bureaucracy in the development of new medical devices and drugs
The problems we are seeing with inefficiency,costs, non-competitiveness, and poor quality inaccessible care all stem directly from the above federal laws and regulations.
Medicare trust was a gold mine until people lived longer, costly medical advances, and lack of political will to increase assesments ultimately threatent to bankrupt the federal government goose that laid the golden egg.
These same wizards, slept while Fannie and Freddie Mae danced to the the tune of Nero Wall street's fiddle.
Now we have to get serious with 1/6 of the american economy. Bernake said it best when he defended the independence of the Fed. Congress cannot be allowed to interfere with the Federal Reserve lest the cancer of politics metastasize to important parts of the machinery of the economy.
One has to wonder why people are so vehmently critical of a government plan that involves additional meddling by novice politicians. The average american still believes in life, liberty and the pursuit of happiness. This pursuit is not possible without the security of high quality readily available health care.
Sam
By way of introduction (and risking sounding too stuck up-but bare with me, as I will come around to making this meaningful), I was trained in NYC at big-name schools/programs, have a degree in health management from Columbia and joined the USAF after 911. Requested and got an assignment in the midwest to be near my kids from a previous marriage and although military life was tough and not for me and my family, I am proud of having served and feel nostalgic about the things I got to do, the deployment, the awesome people I got to work with and take care of and the sense of gratitude for my years of service. We liked the area and the kids were in school so we stayed.
I had moonlighted in the area (hospital & outpatient) before getting out of the military and found it 'OK' to practice in -- lots of 'old-school' psychiatrists in the area, not too biologically oriented and with poor foundations in general medicine and neurology - but, since many of the patients were grateful for a fresh perspective (21st century outlook) I thought what the heck, and took on a job as medical director at a wellness center and added neuropsychiatry to the center. The services took off - but the reimbursement in private practice, the paperwork, the endless and dumbfounding interference with the direct care of my patients by bureaucratic processes, all self-serving the insurance companies' bottom lines are already wearing at me -- only one year after I started the position.
The patients are appreciative, but the economy being what it is, no one is accepting easily the facility's inability to continue with business as usual and for psychiatric and medical services, they are slowly going to full self pay and cash-only (the worse insurance co's went first starting this Sept 1st) with projections to eliminate all of them in the next 6-8 mos if the practice survives that long.
Stable patients being switched from meds because its cheaper and one med is touted to the patient as being equivalent to the other -- yet we have sound (non-pharma) data showing that the mere fact of switching meds in depressed patients, may ultimately lead to treatment resistant depression - and in treatment resistant depression, the more you switch the more treatment resistant they become (STAR-D data). Some other studies show that this might be true for many neuropsychiatric disease states and not just depression (which is a big, common, debilitating, chronic, relapsing, remitting illness that crosses all socio-economic groups and directly costs the world economy not just our own, millions of dollars a year, let alone indirect costs).
I treat a broad variety of patients (not too many of either end: worried well, chronically/severally mentally ill). The majority of people I treatare middle class, working/school-going families with insurance; but it is just these people who will not be able to afford my care. Many of them have co-morbid general medical illnesses or pre/post surgical neurobehavioral complications (because of my other subspecialty).
The very poor have (although many times inadequate for sure) socialized medicine coverage and are protected from the costs of care. The very rich, well, even in economically hard times, being rich means a certain flexibility to purchase those commodities you value (more on this later) as important.
We as a country have an incredible amount of noble-prize winning and nominated talent in all areas of expertise, and yet it is the politicians who will come up with a plan and 'help us' decide on this very important piece of our lives (personal and professional). We (the greatest most technologically advanced democracy the world has ever known) should easily be able to come up with a solution that is uniquely American, and yet can/should encompass all of the good ideas that have been put in place in comparable democracies (and a few that are not democracies -- like CUBA --) from around the world.
I remember seeing the very capable and articulate head-honcho from Mayo on Charlie Rose a few weeks back, describing in a very clear way what we should be striving for: VALUE in our health care system and in the day to day provision of care. As he described it, VALUE=QUALITY/COST.
I am not paid to think. I know I echo what many in our country (mostly primary care, but even Sermo Doc 102s and interventionists have been known to be great thinkers and I have even heard many of them 'complain' out loud of the same limitations).
The clinic where I work out of bills out an hour of my time (double board certified, and board eligible in something else-didn't get to take the board since was deployed to the war) $250.00 (not the cheapest fee schedule but in-line with national/regional averages for neuropsychiatric specialty-medicine care). Depending on the insurance co, they might get a check for 45-48% of that (that includes co-pays) -- and then get loaded with misc paperwork and calls and faxes and on and on to require dedicated/extra staff. How can they stay in business this way? How could I hang a shingle? I have ben asked to partner in the practice and we are negotiating the deal -- but I have my reservations for sure. Yes they could 'negotiate' a better rate - but lets be real, negotiations are one-sided, those who hold the cards make the rules and unless you are large (we can't unionize in the US as physicians) you are out. I am not sure why, maybe the economy, but I have not been able to find any near-by IPAs or anything else that might give a two or three-person shop the leverage needed to truly negotiate a contract. As it is, we have been told by a practice-management consulting group to forget about negotiating better fees in general and for psychiatry specifically.
The value of what I do has been demeaned - which gets me to the point -- a cover article on business week a few weeks ago said it best -- the insurance companies have already won the healthcare reform debate by having shifted the talk away from INSURANCE reform.
These changes to my patient's treatment, forced upon myself and my patients, with no regard for their care, has to do with the business of business---which is business and making a profit. Do not get me wrong - I am a capitalist. Son of immigrants to this great country, they and I have benefitted from a capitalistic democracy and I am a devoted entrepreneur and capitalist; the things that make this a great country are more than just its capitalism, and I acknowledge and embrace that. So do most people (patients and otherwise) that I know do the same -- how many of us do not embrace the knowledge of the benefits promised by a great socialistic program signed into law in 1965 (Hill-Burton act): Medicare.
We must continue along the vein of this kind of thinking -- that their is VALUE in taking care of the health of our elderly, our children, our sick, our workers, our students -- everybody! Don't get me wrong, I too (maybe even naively and ignorant of ALL of its faults) acknowledge the imperfection of the program -- not just as citizen witness and son of two elderly parents who were lucky enough and industrious enough to be able to afford 'extra' coverage in their old age and yet have struggled on limited incomes to purchase medicines and care when the bureaucratic red-tape of signing on/off/part-d etc was too much for them to navigate and they fell through the cracks for a whole year -- but I am witness also as a provider of care, seeing the same as I just described above with my parents, but in scenarios much more disheartening with patients who have not been as lucky/industrious/thrifty/forward-thinking to be able to afford extra coverage. As a capitalist and not a bleeding heart, I know that these individuals are skimping on care, meds and fu and will ultimately cost ME more time, effort and patience as a provider and more of the same as a taxpayer. They will be harder to treat, sicker by the time I see them and more resistant to care from medical and social perspectives. But on top of that I do care, if I didn't I would not be devoted to the practice of medicine as a vocation -- not a business. Should we be entrepreneurial --for sure and there are other things in a medical practice that you can be more business-creative and enjoy entrepreneurship and business ownership/management etc, from.
What I see is that, as a physician, a specialist, a psychiatrist - a provider of care that requires me to think---alot--about general medical concerns, med interactions, nutrition, psychosocial aspects of the patients life, psychological responses -- and then synthesis these into a coherent plan of action and care to the benefit of the patient (not stockholders) -- that this professional that I am and the 'thing I do' ......
that I AM NOT VALUED - my time has no value and my patients health, as a function of the level of training and expertise -- of thinking about their health and ways to navigate the improvement of their situation -- is not valued -- by whom? By the insurance co with whom I have no 'strict' in-the-loop relationship with other than a 'cost' to be managed and curtailed so that the bottom-line of the business is in the black. So that the company can be 'healthy' - not my patient or the practice that treats them and serves a community of patients/workers/taxpayers/retail purchases/students/future populace --- so that the stockholder's purse can be healthy ...certainly not mine, the practice or the 'balance' of credit that would be health in any of my patients.
Desiderio Pina, MD, MPH
Ironically the government has said the system is broken and we need to fix it but as usual the important question of how it was broken has never been asked. It is impossible to cure a disease (except by accident) without first understanding how the disease occurred in the first place. With all the mistakes and ramifications of current federal legislation/laws, it is clearly summarized by an Albert Einstein quote: "We can't solve problems by using the same kind of thinking we used when we created them"
"Federal legislation, laws, oversight and under sight got us into this mess and will not be able to lead us out."
Sam O
Now let us say to solve that financial problem each patient directly paid their primary care doctor $2 a day to be in his practice, or its equivalent in fees for service directly with no third party in the middle, rather like they used to. Let us say the doctor limited his practice to 600 patients. Well, each doctor would generate $438,000 a year. Some might charge more if they were very popular and excellent, some less, but assume $2 a day or $750 a year for the sake of argument. It's the cost of a cup of coffee a day.
If they earned nothing else and had a 50% overhead the doctor would earn a good living, nearly double what current hamster wheel primary care doctors do under third party domination. The doctor would not have to deal with the third party insurance industry very much at all. Possibly, like me, he might also earn 10 to 20% more on big expense items like long hospitalizations that insurance does and should pay for, or maybe he would opt out and not bother to bill insurance at all.
Half of our 900,000 doctors would need to be in primary care to do this. Every American could have a private, personal, secure, real medical home for around $2 a day without third parties snooping in their records. Students, senior doctors and some specialists would flock back to primary care, the original love they were driven from by third parties. The primary care shortage would vanish, perhaps almost overnight. The incentive to do procedures would be reversed. Instead we would be incentivized to form relationships with our patients and treat them as friends as did Russell Anderson. What a concept.
That is our goal. Presented this way who could object to it? Who could not afford it? Those few in need could be helped to join such a practice by charity or government with donations or the medical equivalent of food stamps. But we have to get the third parties out of the way of primary care and basic office practice. Help us get the message to America, Congress and the White House during this important national debate on health care. You at this meeting have much more power than you think. Exercise it.
To demonstrate how ridiculous what we are doing now in primary care really is, imagine what would happen if we insured hair cuts. We would all be issued "MediHair" cards paid for by our tax system. We would present those cards for a "free" haircut to the local barber of our choice. We would seek the best and go often, since it was a covered service under MediHair. But eventually, as we have seen in health care we would be allowed only a buzz cut once every two months by a barber's assistant. It would be functional and take just three minutes and we would all look like marines. Barbers supervising their assistants would be a sad lot indeed.
But many of us would not like how we looked. We would seek opted out barbers and pay directly for what we wanted and needed. Opted out barbers would become the respected and happy professionals and compete to do the best work. We would quickly recognize that hair care is not an insurable event.
Because, an insurable event is an expensive, infrequent, undesirable occurrence nobody wants or expects. In contrast primary care and much of what our consultants do in their offices are not insurable events. What most of us do all day long is expected, common, inexpensive and even desirable. When we insure such events, we destroy them. The past thirty years have certainly proven that. It is time to get back to basics and once more do primary care right, the direct way.
Thomas W. LaGrelius, MD, FAAFP
President, SIMPD www.simpd.org 877-448-6009
It is a philosphical, inductively reasoned iconoclastic essay that tracks the life of a physician as a "para-biography"
Anybody interested in publishing it?
alan
I am an Internist who takes care of patients with very complex time consuming problems . Over the past years I've seen my reimbursement go down as my overhead goes up. I have refused to increase my patient load since that would mean spending less time with each patient and thus providing poor care.My day is bogged down with unnecessary forms and paper work which also takes time away from patient care and increases my overhead.I work all day, am on call all night and weekends and I am paid less than Joe The Plumber.I love what I do and am privileged to be part of the lives of my patients but I can't afford to stay in practice and like many other Primary Care Providers I am fearful that I may not be able to continue to care for my patients.I have 6 children whom I would love to encourage to become physicians but am afraid that after twelve years of higher education and massive costs they will not be able to support a family.I have great faith in your judgement Mr President . i think a public option makes sense but we must be clear that providing insurance to all does not mean quality healthcare for all. Any plan must include resources to allow physicians to spend more quality time with patients . If i was paid at the level I was 15 years ago I would be able to expand, hire new physicians , dietitians,diabetic educators etc and provide better care for my local community but instead Insurance Companies along with Medicare continue to increase regulation ,decrease reimbursement and make it harder and harder for private rural local community physicians to practice. Sure I could move to the city and join a complex mayo clinic type program but then I would be abandoning care in an area where it is needed the most ! ACO's make tremendous sense but these are just another name for the Group Practices that physicians wanted to participate in over 15 years ago but were forced out because of The Stark Laws that are still in effect today. I also believe tort reform is important as well. There is without a doubt bad physicians practicing medicine and those who are guilty of negligence should be prosecuted , but the vast majority of medical legal lawsuits are frivolous and take away vast resources,time and money not to mention cause psychologic injury to well meaning caring professionals. There should be arbitration panels made up of physicians ,legal and scientific experts who review claims of malpractice and only allow those cases worthy of true malpractice concerns be allowed to proceed through to the justice system. This would save a tremendous amount of time, resources and money! I know that a physician complaining about making money is hard to sell to the public but you must realize that the basic problem with our healthcare system is that a secondary economy specifically Insurance companies and big Pharmacy have taken billions of dollars away from the primary providers of healthcare .Is there fraud ?,You bet there is; Is there bad doctors? Yes there are just like there are bad lawyers and politicians. But the vast majority of physicians spent half of their lives and families money and resources studying and preparing to do good for the wold and for the patients they care for . The majority of physicians will do the best thing for the patient if given the opportunity and resources. You must realize that decreasing reimbursement and increasing overhead , regulations and paperwork forces physicians in our present system to see more patients in less time to make ends meet. This leads to unnecessary tests since spending less time with the patient in taking a history or completing an exam leads to relying more on expensive tests for confirmation or ruling out a diagnosis. Doctors then become detached from their patients and no longer know the intricacies of their histories,stories and care needs. This is not something that can be replaced by a computer but rather from time spent with the patient. i believe as you do that quality care should be rewarded and that best practice guidelines should be met but with the present reimbursement system those guidelines may be difficult to meet for many physicians especially if you add 25 million more patients into the mix without increasing resources available to private practices which make up the workforce of healthcare around the country. I love what I do ! I love taking care of my patients but, I ,like the majority of my professional community, am tired and worn out from fighting day in and day out to survive a system where the only real advocate for the patient is the physician who is limited by what he or she is able to do. My decision to become a PCP was made after meeting with my friends father ,who was a GP. I sat in is office and watched in awe as he pointed to the hundreds of patients pictures on the wall each one touched by his care ,each with a life story all of which he knew in great detail. This is what is missing in our discussion.... Thank you
Would it be useful for docs to conduct a few "Town Halls" or "Tea Parties"?
If so, are there any docs out there who are:
1.Good public speakers who can handle nasty people (not me, I'd run)?
2.Doctors who are very knowledgeable about our present medical system
and what health reform needs to be passed in Congress.
3.Doctors who can take any heat later generated by such meetings?
What would SermoTeam do to help if such meetings were held?
Who knows, we might end up with some more good doctors in Congress and fewer lawyers!
I can't believe that every doctor in the country isn't making plans right know to march on Washington D.C. Thursday October 1st, and I'm frustrated that Dan and the folks at medscape haven't embraced and promoted this event.
11. Will Government run Medicine be like other Civil Service positions?...Beaucoup benefits, 4 weeks vacation, 20 years and out! FULL PENSION! Sounding better already? No?
12. Patient's seen at the walk in clinic at the grocery store ALL have fluid behind one eardrum...and are all placed on Antibiotics and Antihistamines...even though none of them have pain, fever, or hearing loss. If it ain't broke, don't fix it! ... and patient's will likely not return with firearms if you say these words honestly and sincerely: "You're going to be fine, and you don't need any prescription medication for your COLD!!!!!" Is this what's coming when Doctors are no longer manning the front lines of patient care?
13. Way back in the '90's the HMO gang showed up with an offer you couldn't refuse...guaranteed patients, reasonable pay, and less paperwork. Everyone went for the bait! The noose tightened year by year. Turned out to be plenty of patients, lessening pay, and mountains of paperwork...Today's advice:DON'T TAKE THE BAIT.
14. If "Healthcare" is a guaranteed right under the Constitution of the United States, then people who can't see and/or hear properly should either be on disability, or should be provided correction for their sensory deficiency (glasses and/or hearing aids). After all, Medicare provides canes, walkers, and all other sorts of assistive devices...why not the most basic of fixes for these most debilitating of problems?
15. If BC/BS of NJ is a not-for-profit company, and they have billions in reserve...and they made zillions last year, why were they granted a rate increase this year?...must be that clean "Jersey Air".
16. There are more ED commercials on TV than commercials for beer and breakfast cereal combined! Why not have people call 911 in case of an erection lasting for more than 4 hours? Then, they'd abolish these commercials and perhaps replace them with public service spots informing people about health and disease. TV viewers might better understand what the hell goes on in their bodies, prompting them to take better care of themselves, and empowering them to use the Medical system more wisely. Maybe we should also spend a few more dollars and hours teaching kids about their health as well!
17. If you go shopping, likely they will not let you leave the store with your purchases until you pay for them? But, it's okay to forget your wallet-checkbook-credit card combo when going to the Doctor's office! If I see a patient, and only once at the checkout window they indicate that they can't pay today, can I have them arrested for shoplifting?...oh, right!...they'll send a check!
18. There are currently about 15 'sharps' in my "red box" at the office...but the average Diabetic leaves 10 times that at the curb every month! I pay a fee (tax?) as a "Medical Waste Generator", AND then pay to have the boxes carted away as well...that's seems about right!
19. If I worked for a Company...let's say, a Wall Street firm...and I did half of a good job, I'd probably get a raise fairly regularly, and perhaps, an occasional promotion. Not in this job! My take home has fallen year after year as my overhead has risen! AND, I earn the same paltry dollar amount for each service that a Doc fresh out of school or residency would get. No disrespect, but my 25 years of experience frequently has me doing the job ... dare I say ...better ... and more cost effectively. And the Doc 40 years in practice?...(yikes!)...should be a few pegs up from me!
20. Who decided that the fee for "stick out your tongue and say ah" was "bend over and drop your pants"? Why should Congress both decide MY PAY, and also set and regulate their own salaries? Isn't that a bit backwards? I should set MY FEES, and WE should determine their salaries!
Follow the money! especially the money with no value added for health or well being of patients. I tried to ascertain how much reducing Anthem's excessive costs could lower premiums. I was unable to get the number of Anthem subcribers in the state of New Hampshire, either through direct inquiry or through a local newspaper reporter. If you took the $30 plus million bonus from 1 CEO in 1 insurance company and divided that among the subscribers, you would be able to lower premiums by hundreds of dollars. This would make health insurance more affordable for those "on the fence", which is a large percentage of the uninsured. Go through the same math industry by industry and money is there to be saved.
Instead the politicians stay away from those that give them money and try to cut fees on everyone else. The politicians have corrupt motives and should not be allowed to "fix the problem". They are not addressing the problem correctly,only trying to get re-elected.
NEW REFORM PLAN:
1. Tort Reform
Remove trial lawyers like Specter (PA) from Congress in 2010 and stop Trial lawyers PAC and lobbyists. Indict corrupt Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform
Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies which prevents free maket competition! Allow interstate sale of health insurance with more competition, lower premiums, portable policies, and better deals for docs.
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers and/or patients who use them. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills. Prevent him from superimposiing Medicare Reimbursement onto private Health Insurerance CO's which is simply a disguise for a new "Public Option"; there will be more garbage to follow.
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
Inform your patients who vote by whatever means possible, the media could care less as they love B.O. Go on the Million Med. March to D.C on 10/01/09 if youcan. Have your own Town Hall with your patients. The fight against the British overlords began with a few farmers in Lexington and Concord; can't we fight back like they did with our actions and words??? (Forget T. Kennedy, think Dr Albert Schweitzer.)
The longer I do this, the more I have come to understand that listening is the most important thing I do as a physician, it is not high tech but to be heard, reallly heard, is critical to healing. Unfortunately this is not what is valued in our current medical climate.
Physicians who spend more time with patients are considered under productive.When did medicine become another production model and when did patients become units of production? A recent article from a popular physician business journal recommends that doctors give up their lunch time, eating on the run so as to see more patients and be successful. Am I the only physician who thinks this is crazy? Lunch time is my opportunity to catch up with paper work and return phone calls. As it is I have taken a second consulting job to try to keep up with expenses. I have made a priority of spending time with my patients, but I don't believe I can afford to stay in business much longer.
I was disappointed to see our local spa charges more for make-up consults, hair coloring and perms than I see from Medicare for my services. Since graduating from medical school, doctors have been battling with Medicare to prevent the projected paycuts based on the SGR. With the impending cut of 21% to physicians in 2010, frankly I just don't have the stomach for it anymore.
Everyday has become a struggle. Irate patients swear at my office staff when insurance denies coverage for prescriptions or referrals I recommended. The patients identify their physician as the face of medicine and take out frustrations on my staff and I frequently. Although my biller has become resigned to this behavior it is not right. I have found that there is a general sense that medicine is just another consumer product. Patients expect to call up and get treated for free over the phone so as to avoid an ever rising copay. I find it sad that they do not even realize they are asking for substandard care. I still think there is a lot of value in the medical exam and observations made while you are interviewing the patient but today people place very little value on that and have come to accept less.
Then there is the issue of fear. Everyday I have to wonder if this is the day I get sued. This fear drives up the expenses related to our health system. Patients have come to expect a high tech eval for every symptom and physicians are afraid to deny their requests.
I would like to work toward improving our health care climate. It is imperative that those of us working "in the trenches" are part of the discussion. I fear a collapse of our primary care base and that will be very sad indeed.
Remember the farmers at Lexiongton and Concord where our Nation was born! Can you say " I've just begun to fight"?
Come on guys, don't give up!
About half the patients I talk to about this seem to appreciate the need for appropriate reimbursements and salaries for physicians and they have an appreciation for how hard we have worked. Maybe half is a bit high and it might depend on where you live.
Maybe a large poll of random patients would be helpful. With questions such as: What is the average med school debt, total years of training to become a physician, average physician salary, time a physician spends working on their case besides face-to-face time, etc etc. This might be publishable when compared to the facts. And for the ones who are not moved by the stories and letters from physicians who will be closing their doors, it might be more informative when opinions vs facts are compared side by side.
Sadly, Americans might have to experience poor quality healthcare that we'll ultimately see within a couple decades if govt run healthcare is initiated. The system will continue to ride the wave of quality care brought about by years of advancing technology and research and by caring physicians who will continue to treat their patients. The change might be slow. Eventually, the public would want the current system back, but would be near impossible with govt in charge.
I have worked at the Dallas VA, at Parkland, the county hospital in Dallas, and at JPS the county indigent health program in Fort Worth. I can't say pt's didn't get care. They did. But what they suffered through was government employees who were often rude, long waits, inefficiencies of care delivery. That is what you will always get in a government run health program.
Few would however, argue with their physicians' knowledge of health care and the challenges of managing their patient's health in an every changing and dynamic world of medical innovations, limited only by the costs of those advances. Physicians in Central Ohio formed the only physician owned and managed health insurance company in Ohio, we uniquely placed the physician's voice squarely in the center of a health insurance company intended to bring affordable evidence based medicine to the citizens of our state. Rather than being driven by Wall Street analysts' quarterly dividend reports, The Physicians' Assurance Corporation (TPAC) reached out to employers since its inception a year ago, and worked towards tangible costs savings goals with wellness programs. Also included in their model were instituting peer review panels, clinical integration programs, credible pay performance measures, creating Health Care Alliances. Despite growing quickly to insuring over 8,000 citizens in Ohio within its first year of business, TPAC faced a capitalization crisis. They anticipated being at a break-even point second quarter of 2010 and in the mean time was not able to fulfill the state's minimum surplus. As a result TPAC was forced to liquidate by the Ohio Department of Insurance last week. We ask for your assistance to add your voice to ours and continue the mission that the physicians in Central Ohio tried to start - offering a physician driven solution to the health care crisis in our country. It is our belief that the continued implementation of this model will provide some answers to many of the questions and dilemmas facing health care and health insurance in the coming years.
Dr. Sue M
Seattle, WA
Internist-Primary CAre
Meaningful tort reform could drastically reduce the cost of medical care by reducing the number of tests ordered in the practice of 'defensive' medicine. Obama has suggested his reluctance to enact tort reform is because it might hinder an injured patient from obtaining compensation. Far be it from me to suggest this reluctance has anything to do with Democratic backing by trial lawyers. Perhaps a government backed malpractice insurance program (similar to the VA) could be devised such that the cost of malpractice premiums would be taken off the back of the physician which would go a long way in lowering physician's concern. Something akin to a "3 strikes and you're out" clause could remove physicians who have a reason for concern regarding their quality of care. But just to bury one's head in the sand in regards to the true cost of practicing medicine (as Obama has done) defies logic.
466 fl docs sign the letter
that a major statement
-59
I am:
Mark Mann, MD
Clinton, Oklahoma 73601
Family Medicine
American physicians have to commit to a better solution, it is going to require everyone's input and much focus on using the health care dollars efficiently. One of the best ideas is health care saving accounts, that puts the motivation and control in the hands of the people receiving the health care. It also gives them incentive to live healthily. Hopefully we will have leadership in this area that will call everyone to the table, realizing that human nature is being what it is will tend for an easy way out. Health care is not a right but a responsibility of us all.
1. tort reform
2. one health payer system - sounds radical but it must be done to do away with the $31 billion / year insurance bureaucracy - all the think tanks are on board with this.
without medicine being an attractive job for those with smarts, you're going to have a potentially drastic drop in quality of physicians.
CD
The fact that 12-14% of the GNP has gone for medical costs since the early 80's hasn't changed--it remains the same. But reimbursement to physicians steady has decreased. Now the money is deverted to peer review, rehab managers, and other agencies that "control costs". At the same time, insurance costs soar while patient benifits and physician reimbursement steadily decrease. Don't blame the physician it is the insurance companies that need top be investigated and managed. But then again, they have a pretty good lobby--so most likely nothing is going to happen.
Does anyone know what the "government health plan" is?
In most cases, you don't need an MRI to know when a patient needs surgery. But if a diagnosis of a tumor is delayed in this manner, a physician would not have a legal leg to stand on. If the goverment is planning to decrease costs by "managing" care, the physicians would have to be legally protected, otherwise they would have to be crazy to participate in such a plan.
air traffic control,
banking,
the auto industry,
a balance National Debt,
and health care....
WHO DECIDED THAT?...and do you remember voting on any of the above.
If you want a National Health care plan--with ability to have access to the best medical system, physicians, equipment and hospitals in the world, It has to be well thought out, and cannot just be pushed through Congress just because it is on the agenda. But as my dad said: "Common sense must be a special gift from God, because so few people have it."
Having been in surgical practice for 30 years I have seen my share of malpractice cases. Most cases are as a result of a less than desired outcome. Many times disasters occur in very ill patients that were not the fault of the Sermo Doc 102. Often these disasters produce severe financial loss for the patient. Why can't these patients receive some form of compensation (or at least coverage of their bills) due to the disaster without having to assess blame.
Lawyers argue that it is the blame that keeps the system clean by weeding out bad doctors., What if the state licensing agency reviewed all disasters that occurred. Those would be categorized (as is done at M&M conferences at our hospitals and universities) preventable or nature of the disease. Preventable can be further subdivided into errors in judgement and errors in technique. Should a physician make too many preventable errors, their license might be revoked or remedial action recommended. Problem solved.
A final plus is there are some doctors that have catastrophe after catastrophe but for some reason don't get sued so they stay below the radar. They would be uncovered with catastrophic insurance.
The best part is it would be part of regular health insurance so no premiums for the doctor. The insurance would be funded by the enormous savings by eliminating depositions, expert witnesses, and jury trials - we are talking multi-millions.
So - I'm told the lawyers will never go for it. Like what else is new. How do we get our legislators to buy into this?
I am a clinical neuroSermo Doc 102, in active practice, and graduated from medical school in 1968. I have practiced in the military, in an academic setting, and in private practice, and by this time have seen about everything. I have also watched the inexorable deterioration in the physician's ability to care for his patient over the years. In the early 1970's I heard the phrase over and over again "healthcare is too important to be left to the doctors." Well, we now have in the hands of politicians, lawyers, and business administrators, and I don't think we're any better off. In fact, every time any one of these entities meddles further, things get worse, and today healthcare is probably the most restrictive industry we have, and patients have not benefited from this. So, I am happy to see this amount of public involvement.
It certainly is time for a change, but not the change envisioned by our legislators. Had I made it to the meeting, one of the things I would have asked about is the proposed "single-payer program," I believe a disingenuous proposal. The fact is medicine has always been a single-payer program, and that payer is you, dear reader, the patient (read "taxpayer," if you wish). What is really happening is that there is now a great debate going on as to who gets to be the intermediary, the entity that controls the flow of money between the recipient and payer (you) and the provider (me, or a hospital or other such facility). Up to this time the intermediary has evolved into either the government or an insurance company or similar entity. The government, especially the government we seem to have voted into power this cycle, seems the more ominous of the two, because in assuming this power the government is edging toward defining life itself, which it clearly is already in the process of attempting. Personally, I think this is dangerous, but that in no way exonerates insurance companies or other such entities. As the alternative intermediary, the insurer is simply the lesser of two evils, and that includes all kinds of insurance, even malpractice insurance, also known to us as "the lawyer magnet," a closely related issue receiving scant attention in the most prominent proposals.
But the real question to the American public is and should be "why do we need an intermediary at all?" We were doing quite well before the introduction of third-party payers. And, we have always had charitable institutions, as we still do, to take care of those who could not afford to pay. The word "charity," however, is unpalatable to some, and so we use the word "entitlement," engendering a remedial program, and of course once again we have burgeoning intermediaries to administer such programs.
I hope we as citizens have come to recognize finally that all of these intermediaries are siphoning off too much of the money and more importantly at a deeper level, too much of the power. It is time to ask, critically, if they were ever needed in the first place. The introduction of third parties into medicine was not the answer. Now, it is the problem.
Since item 4 doesn't directly conflict with my beliefs, I'm signing the appeal. But I'll be meeting my Senator in a Town Hall next week and will urge him, as I have already urged Obama, to regroup and get a single-payer non-profit system on the table--something like Canada's was in its first 25 years before it was sabotaged and eventually eviscerated by private-interest administrations and lobbying from the insurance industry resulting in "creeping privatization." Shopping for health care should not be the same as choosing between steak and bologna, or trying to predict your medical needs and life situation five years into the ftuture
Private insurance is to health care as Haliburton and Blackwater are to military policy and operations. Capitalization has a crucial place, but not in the delivery of health care..
(no, not that ACE, only this ACE is covered) and by non-doctors giving "report cards" on my excellent charts (Medicare once refused to pay for a pneumovax, because the nurse did not initial it was actually "given", though I had written the order......oops, Medicare....now I have to absorb the cost of another pneumovax). And of course, trying to convince an HMO that a patient really does need an MRI on their knee which gives way on the stairs
Seven years ago, I started a full-time, non-profit medical Clinic for people without health insurance. No other rules. No financial screening. No government money. No geographical boundaries. Simply high-quality care in a lovely setting for persons without insurance. Payment as each can afford.
Now, with very busy practice, we have FP, IM, Gyn, Derm, PT, psych, Peds, Uro....apart from two paid doctors, ( 1 and 1/2 actually), all others are volunteer. We have 150 acftive volunteers (clerical and clinical). We have 1000 patient visits a MONTH now.
And when people finally do get insurance, they don't want to leave, as more than one of them has said "I've never been treated as well as when I've been here.....you all actually LISTEN to me")
Of course there are problems: it is well nigh impossible to get a non-emergency surgical problem fixed; we have a man walking around with a huge LIH with a big truss, trying to work full-time as a pizza maker, but he cannot get it fixed as he makes too much for medical assistance and cannot afford to buy insurance privately.
And we have a woman with gall stones and intermittent severe pain, but cannot get it out for same reasons.
But the joy of going to work and NOT having insurance forms, formularies, HMOs etc etc etc is great, and I am enjoying medicine as never before
We do need no-fault insurance for adverse effects, the inevitable few bad outcomes of good and appropriate care. People who had bad outcomes may sue simply because there is no other source of funds to pay for their disability . . . and giving these individuals economic compensation outside the tort system would instantly and permanently reform that system.
Thank you for your attention.
By coincidence today, I was wondering today what our Great Indian Nation, including a relative, might think about Obama Care and chanced upon this from the WSJ:
Montana Sen. Max Baucus, a leading architect of national health-care reform, visited the Flathead Indian Reservation near Pablo, Mont., in May, and he was confronted with a surprising critique. "I hope any [new health-care] plan does not forget the nation's first people," Dr. LeAnne Muzquiz told the senator. Another person in the audience, according to the newspaper the Missoulian, followed up by telling the senator that the legislation pending in Congress would in fact do just that.
Native Americans have received federally funded health care for decades. A series of treaties, court cases and acts passed by Congress requires that the government provide low-cost and, in many cases, free care to American Indians. The Indian Health Service (IHS) is charged with delivering that care. The IHS spends about $2,100 per Native American each year, which is considerably below the $6,000 spent per capita on health care across the U.S... about on par with Finland, Japan, Spain and other top 20 industrialized countries.
Unfortunately, Indians are not getting healthier under the federal system. In 2007, rates of infant mortality among Native Americans across the country were 1.4 times higher than non-Hispanic whites and rates of heart disease were 1.2 times higher. HIV/AIDS rates were 30% higher, and rates of liver cancer and inflammatory bowel disease were two times higher. Diabetes-related death rates were four times higher. On average, life expectancy is four years shorter for Native Americans than the population as a whole. Rural Indians fare even worse. A recent Harvard University study found that life expectancy on a reservation in neighboring South Dakota was 58 years. The national average is 77.
Horror stories are common on reservations, where the common wisdom is "don't get sick after June"—the month when the federal dollars usually run out. In July 2008, the Government Accountability Office reported that the IHS simply lost $15.8 million worth of equipment such as trucks and Jaws of Life machines between 2004 and 2007. It also found that $700,000 worth of computers were ruined by bat dung.
The Chippewa Cree Band has opted to provide its own health care with funding from the IHS. Dr. Dee Althouse, a physician at the Rocky Boy's Reservation, is still frustrated by funding constraints. She told the Montana Quarterly that she often finds herself working to save lives and limbs, deferring routine health care until there is money available. Yet even with limited funds, ongoing research by the Native Nations Institute reported earlier this year that tribal management leads to better access and better quality care than relying on the IHS-run system. The Chippewa Cree Band runs its own hospital and has hired a registered dietician who has gotten the local grocery store to implement a shelf-labeling system to improve consumer nutritional information. They've also built a Wellness Center with a gym, track, basketball court, and pool. These are small steps that won't immediately eliminate heart disease or diabetes. But they move in the direction of local control and better health.
At a time when Americans are debating whether to give the government in Washington more control over their health care, some of the nation's first inhabitants are moving in the opposite direction.
•(Mr. Anderson is executive director of the Property and Environment Research Center in Bozeman, Mont., and a senior fellow at Stanford University's Hoover Institution. WSJ OPINION: CROSS COUNTRY, AUGUST 28, 2009, 6:44 P.M. ET.)
So then, if our Indian Nation cannot survive under the present Government System, God help them under Obama Health Reform. Please sign the Appeal, I did.
I am not signing the petition. The above quote implies a legitimate role for government in health care as a partner in seeking our goals. That is wrong.
There should be total separation of the government and medicine and I belive this petition will undermine the objective of totally free markets in medicine which should be the goal of all physicians and patients.
www.pbs.org/moyers/journal/08282009/watch.html
Increasing interventional proceedure Medical Care will lead to bankruptcy. Medical care, at it's heart, is one on one, listening and talking, showing the loving care to work to ease the suffering of the patient.
AP - By JIM KUHNHENN, 2 hrs 38 mins ago
WASHINGTON - A leading GOP negotiator on health care struck a further blow to fading chances of a bipartisan compromise by saying Democratic proposals would restrict medical choices and make the country's "finances sicker without saving you money." The criticism from Sen. Michael Enzi, R-Wyo., echoed that of many opponents of the Democratic plans under consideration in Congress. But Enzi's judgment was especially noteworthy because he is one of only three Republicans who have been willing to consider a bipartisan bill in the Senate. He called for more competition among health insurers, for the ability of small businesses to band together across state lines to negotiate for lower-cost insurance plans, for tax breaks to help people buy insurance and for reducing malpractice lawsuits. "The Democrats are trying to rush a bill through the process that will actually make our nation's finances sicker without saving you money," Enzi said. Democrats also are calling for cuts in Medicare spending, using some of the savings to help uninsured workers. A House bill would result in a net reduction in Medicare of about $200 billion, though Obama has insisted the reductions would not cut benefits in the health program for the elderly. But Enzi said: "This will result in cutting hundreds of billions of dollars from the elderly to create new government programs." "We're a nation of people who want the ability to choose what will best fit our families' needs and it should be that way with health care, too," Enzi said.
Perhaps we've got a chance for starting over proper reform!
Mr. Rogers (MI) HITS A HOME RUN IN CONGRESS FOR OUR TEAM!!!
Ok, this is worth every MINUTE (ONLY 4) to watch this! THIS HITS IT OUT OF THE BALL PARK! AND IT ONLY HAS HAD 24,048 views...
It was taken inside Congress with a Congressman... YOU HAVE TO WATCH THIS...and YOU MUST, MUST PASS THIS ON!!!
THIS IS IMPERATIVE EVERYONE SEE THIS!! IT WAS TAKEN OFF THE VIDEO TAPES OF THE FLOOR OF OUR NATIONAL LEGISLATURE...
PLEASE GET THIS OUT TO EVERYONE!!!
(hold down Cntrl and Enter or copy and paste in web browser if this doesn't work)
CLICK HERE OR COPY/PASTE INTO YOUR BROWSER.
www.youtube.com
WHERE HAS MR. ROGERS BEEN THESES PAST FEW MONTHS!!
OUT OF THE BALL PARK... A HOME RUN!!!
Mr. Rogers (MI) HITS A HOME RUN IN CONGRESS FOR OUR TEAM!!!
Ok, this is worth every MINUTE (ONLY 4) to watch this! THIS HITS IT OUT OF THE BALL PARK! AND IT ONLY HAS HAD 24,048 views...
It was taken inside Congress with a Congressman... YOU HAVE TO WATCH THIS...and YOU MUST, MUST PASS THIS ON!!!
THIS IS IMPERATIVE EVERYONE SEE THIS!! IT WAS TAKEN OFF THE VIDEO TAPES OF THE FLOOR OF OUR NATIONAL LEGISLATURE...
PLEASE GET THIS OUT TO EVERYONE!!!
(hold down Cntrl and Enter or copy and paste in web browser if this doesn't work)
CLICK HERE
www.youtube.com
YOU MUST WATCH THIS VIDEO!!!
But, in case you need more entertainment, try this one:
www.youtube.com
It's also very odd that there's no option that says, "I don't support the appeal"
Reduce physician overhead and eliminate defensive medicine costs by completely doing away with the tort system of malpractice. INSTEAD, substitute a system in which complaints of malpractice are evaluated by a team of physicians, lay people from the community, and others to result in two outcomes whenever genuine malpractice is found;
1. A system of compensation for the injured party.
2. Practice penalties for the physician up to loss of license. A lesser degree of culpability might result in a limited licensure with active, vigorous, on the spot supervision of similar cases (compensation going to the supervisor, not to the offending physician).
Without some kind of explanation of the alternative that you propose to each of your points, it really is unacceptable, at least to me. And believe me, I have had just as much difficulty with managed care, reduced reimbursements, malpractice garbage, etc., etc. as anyone else.
is slavery. I thought we struggled 200 years to
end this custom and here we are trying to reinvent the wheel
We need to let our voices be heard as loudly as possible. Talk to your patients as they're the ones who vote! Set up Town Halls or Tea Parties, write letters, send faxes, and do it overe and over, not just once.
Together we are a loud and powerful voice. We can and will be heard!
Fight the GOOD fight!
Seems like Dr.Frist's Senate service had been about nothing so much as profiting from the suffering of the nation. By blocking needed health care reforms, pushing for tort reforms that would limit malpractice payouts and supporting moves to privatize Medicare, Frist pumped up his family's fortunes at the expense of Americans who lacked access to health care. As Mother Jones explained, "Some companies hire lobbyists to work Congress. Some have their executives lobby directly. But Tennessee's Frist family, the founders of Columbia/HCA Healthcare Corp., the nation's largest hospital conglomerate, has taken it a step further: They sent an heir to the Senate. And there, with disturbingly little controversy, Republican Sen. Bill Frist has co-sponsored bills that may allow his family's company to profit from the ongoing privatization of Medicare."
The Frists fared well during the senator's two terms. An $800-million stake in HCA that his father and brother had at the time Frist was elected in 1994 shot up in value over the decade that followed. Frist's brother, Thomas, rose steadily on the Forbes magazine list of the world's richest people in recent years. In 2003, Forbes estimated that Thomas Frist Jr. was worth $1.5 billion. According to Forbes: "source: health care."
Corruption is rampant in Congress. All of us together can weed it out!
I cant stand HCA, however Frist's beliefs are more in line with the majority of physicians as opposed to the idiot Howard "the duck" Dean
limits to the thiefs in the insurance industry. There should be no reason for denials and no claims conveniently ignored anymore. The insurers need to finally be held accountable and actually pay the doctors and hospitals for services rendered to the patients they have agreed to cover. INSURANCE REFORM!! Talk about saving money... Millions of dollars could be saved by not wasting valuable time and money on appeals, phone calls, certified letters....
Rep. Shadegg: Obama Misleads on Healthcare
Wednesday, July 29, 2009 3:01 PM
By: Ronald Kessler
President Barack Obama has been making misleading claims about his healthcare proposals, Rep. John Shadegg, an Arizona Republican, tells Newsmax.
Shadegg, a member of the House Energy and Commerce Committee, notes that Obama said in his speech on healthcare reform that the legislation he and congressional Democrats propose "will keep government out of healthcare decisions," and Americans will have "the option to keep your insurance if you're happy with it."
In fact, Shadegg says the House bill "inserts the federal government and federal bureaucrats in virtually every healthcare decision in America. And, under the clear terms of the bill, you will not be able to keep your current plan, whether you like it or not."
Shadegg sees the House bill as a "massive takeover of every aspect of healthcare." The legislation "empowers bureaucrats to make virtually every decision," he says. "It creates a new healthcare advisory commission, a new healthcare benefits board. It creates a new commissioner who would have powers just short of the powers of the president.
It dictates what must be contained in every policy in America, down to what they must cover, what appeals process it must have, all the way down to how insurance firms must advertise in a manner acceptable to the federal government. It is a massive federal government takeover where bureaucrats and the government will be involved in every healthcare decision."
Ronald Kessler is chief Washington correspondent of Newsmax.com.
www.newsmax.com
===
So, we either stand up and take action as Sermo Doc 382 has stated or live in more misery with ObamaCare! You will have NO SAY WHATSOEVER and will be subject to revocation of your license and/or fines if you don't follow his Regs.
"PCPs in all other countries with socialized medicine make even less than American PCPs. In the eastern european block they drive cabs for spending $. In Britain they have side private offices. In Canada they go to Florida for two months a year when the $ stops."
I would like the sources of this information please. Thanks.
Sermo Doc 3892003@yahoo.com
You both could be a "Doc in a Cab" whereby you could provide a Medical Service while driving a cab. You could collect the Medical Bill and the Cab Fare, both for cash!! No Government Plan, No insurance co. No HMO. Why not?!
What a Dream!
I support any effort to help the physicians
Why am I bitter?
Why am I verging on bankrupcy? I have no control over the price I charge for my care that I give my young patients. I either accept the fee offered by the insurance company or leave their panel. 99% of my patients are enrolled with HMO type of insurance. If I leave their plan, they would leave my practice, even though they "love" me as a caring physician.
Less than a year ago, a 17 year old patient developed Hodgkins' disease. I strongly advised they choose the oncologist I knew was one of the best doctors I've ever met to treat the disease; he graduated from Hopkins with me. My friend cured their son. They were grateful to me for all the (unpaid) time I spent advising them. But last week they were annoyed that they had to pay another "co-pay" of $15 when the young man developed a dermatitis and came to me for treatment. This dermatitis looked a lot like poison ivy or latex sensitivity around the wasteband. However, considering the young man's history, I was more concerned and looked at the rash very critically.
This is the stress the primary care doctor is dealing with. The family actually doesn't understand that I dont "charge" a co pay; I "collect" the co pay THAT IS DEDUCTED FROM THE $50 FEE THE INSURANCE COMPANY THINKS MY EXPERTISE IS WORTH.
Tort reform MUST be HAMMERED home in any reform. THE IMPOSSIBLE COST of medical care is DIRECTLY tied to DEFENSIVE medicine. Every doctor is at risk of being blamed if anything bad happens to a patient. A lawyer is waiting for every unfortunate outcome.
Addendum
I didn't expect to be making $140,000 with 6 days worked each week at the age of 56.
Am I greedy or lazy that I want to be making as much now as I did in 1987?
PRIMARY CARE DOCTORS ARE GETTING SLAMMED?
In fact we are now calling ourselves "PROVIDERS" as the insurance industry has come to call us and the physician extenders.
The insurance industry leaches have to end their control.
Obama Socialism:
"Obama had the 1000 page "Healthcare Reform Bill" written and submitted to congress hoping they'd ram it through like his stimulus bill. What is in there (HR3200) is WHAT he wants...PERIOD! The fact that idiots cannot see what they are reading is a testament to their government school educations and democratic endoctrination as sheeple. Maybe Obama should have labeled his plan Shock and Awe for the aged and infirm. Maybe Operation Enduring Freedom for illegal immigrants and the entitlement minded. In truth Obama's healthcare reform is a tobacco smoke enema for the drowning American taxpayer. All roads lead to socialism with Obama at the wheel. And don't even cry that he won, get over it crap...IF he had ran on a platform calling for socialism he'd have been laughed off the stage. He lied and his agenda is clear. Too bad you (Americans) bought it, shut up, learn your lesson and go on."
Posted by Tujeez on Sun Aug 16, 2009 6:45 AM ; Augusta Chronicle.
Our fellow citizens voted for a Socialist for President, one who is determined to implement his Socialist agenda now, now; do you really think they'll change overnight and help us? There's a bridge for you in New York!!
God help us all!
We make a platform, and then pin-down those congressman and senators who disagree. Then, get the word out--conservative talk radio, FOX, etc, and then
BACK political opponents---and vote these bad folks out. Use your office and
place posters to advertise which politicians we favor (each locally) and which we
don't. Send letters to your newpaper editor. Support your state political action
comittee. Send money to support the physicians already in congress to further
support us. Teddy Kennedy passed---which in terms of health care reform shorts
the bad guys one leader. If the Swine flu hits as hard as has been predicted,
maybe the population at large will view their physicians differently. We must
hang together gentlemen---or we'll surely hang separately.
In 1930's Nazi Germany there was:
Anti-Christian/Anti-God, Anti-Family teachings
nationalized education and health care
suppression of individual rights (anti-gun laws)
disregard to human life (euthanasia, abortion)
anti-morality teachings (the concept that there is no right or wrong except defined by the government)
government defines moral issues rather than religion (gay marriage)
removal of religion as an influence in society
By the early 1940's the German government controlled almost ALL aspects of an individual's life. This is SOCIALISM.which we face!
We need to act like Dr. Sermo Doc 322 says above. You can't wait for "the other guy" to do it for you. We all must act forcefully in whatever way each of us can and now before 50 Democrats in the Senate decide our fate!
Based on my experience and observations, the current "health care reform" effort lacks credibility.
Three essential concepts of meaningful reform are tort reform, single payer, and pharmaceutical negotiation to lower prescription cost. That all three are "off the table" by those advocating "reform" is very telling.
I did not vote for President Obama. With his election I admit to having hope for meaningful change at the Capital. Now over six months into his presidency I find the same old spin, Washington "insiders" controlling information to the president, back room deal making, misleading information, grandstanding, secrecy, deception, and duplicity which has wearied me since I became elible to vote some decades ago. Indeed, I have new respect for Mr. Obama's ability to "fake right, break left" honed in his basketball experience. TK
It is a very clear and strong statement about the problems of Health Reform which we're discussing here.
Please take a few minutes and watch it.
CLICK BELOW OR COPY/PASTE INTO YOUR BROWSER.
www.youtube.com
Thank you all.
www.youtube.com
The Title is: Congressman Mike Rogers' opening statement on Health Care reform in Washington D.C.
Please watch, he's a cancer survivor.
An example: here in the developing world we "still" do surgery for PDA ligations. Why? Because device or coil closure is MUCH more expensive, and we can do surgery with great results, through a tiny "bikini" incision and the kid is out of the hospital usually the next day and needs no follow up care after the usual postop surgery visits.
I am not in favor of the current proposal(s) and am completely opposed to "rationing" healthcare, but I do think we need to do an honest assessment of what things cost and put that into the equation of what treatment to recommend. If the patient (for whatever reason) has a preference for a treatment that is significantly more expensive and without demonstrated (medical) benefit, I think the patient should be expected to bear the increased cost (either at the time of treatment or by means of a higher priced insuranc policy), not the taxpayer.
basic medical care for every body, health care for all children till 12 th grade
GO GREEN, RECYCLE CONGRESS!
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
(Reform and Revolution in 2010 election!)
Duane Graveline MD MPH,
family doctor
1. Tort Reform Remove trial lawyers from Congress in 2010. Indict corrupt Lobbyists and politicians. Pass a Tort (Malpractice) Reform Bill.
2. Insurance Reform: Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies
3. HSA's: Implement Employer HSA's adding tax credits/deduction for Employers/Employees. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.
4. Defeat all Obama bills. Prevent him from superimposiing Medicare Reimbursement onto private Health Insurance CO's (new "Public Option").
5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.
6. EMR's: Paid by Gov. stimulus plan, not doctors.
Inform your patients who vote by whatever means possible, the media could care less as they love B.O.
Go on the Million Med. March to D.C on 10/01/09.
Sabah E Acho MD
:-)
We need honest discussion from our President about real reform, its costs and how to control them. I have yet to hear it.
The Congressional Budget Office weighed in yesterday on a proposal that the Blue Dogs have pushed to control costs, a new independent commission to oversee payments made by Medicare, the government program for the elderly. The CBO estimated the panel would save $2 billion over 10 years.
If there is to be a new Commission to oversee Medicare payments, it should be PRIVATE and INDEPENDENT of Congress and the W.H. It should have a majority of physicians on it (Primary Care inc. Fam. Med, Surgery, and I.M.) as well as elderly patients, not just Obamacrats.
Any ideas out there?
1. It doesn't speak in sufficient detail. For example, how do we get insurance companies out of the medical practice business. Get rid of the insurance "middle man!"
2. Tort reform is important, but reducing costs requires a lot more than malpractice reform. We need to get rid of fee-for-service and physician-owned health care facilities.
3. Signing as "America's Physicians" is misleading. This only represents readers of SERMO.
4. There is no "I vote no" option.
why don't these lawyer-hating [or is it just legal recourse hating] docs simply run for congress...after all, who is the government, but us, the people of these united states [commonly referred to as "Americans"]?
I do not understand the constant railing against CPT coding. My long memory recalls that the old UCR method was fraught with many problems. Don't you think that it is better to have a way to describe services?
A Doctors group, the Assoc. American Physicians and Sermo Doc 102s, is suing the White House and the Company who sent out phishing emails to people who never signed up for WH emails, never had contact with WH by email, and never requested anything from the WH by email.
There's a big data base out there under control of the WH which can be used later.
How do we create a Lawsuit against The American Trial Lawyers Association ? We must have serious grounds going back decades????
Good luck to the AAPS!