If the AMA evolves any more than they have,everyone will drop their codes/coding.It will be a theatre of the absurd.There will be no need for a call to action.The COMBUSTION will be spontaneous.Doctors have learned and suffered enough to strive for more independence in 2010.That,I believe,will be the only noteworthy difference;incomes will probably continue its lag on inflation but will remain relatively stable.Contrary to popular thought,Doctors are not stupid;most have families to feed and loans to service.People will shop for and purchase what they can afford with regards to health care.They cannot legislate the indications for a nuclear stress test and other clinical decisions.No panic from where I stand.Otherwise,I'll get out of Dodge:-)
I detect an undercurrent of optimism in your writing, Dan. From where I sit that feels good. My assumption is that your view is much broader and more detailed than the majority of us.
EMRs are a known cause of FRAUD.CIOs can prance around as much as they like;I will not adopt an immature system that induces 'practitioners' to print out 4 pages of meaningless clinical notes after a less than cursory evaluation.You know for sure the NPs,PAs,DNPs and other small mammals are 'tumescent' with the idea already:-) I generalize, of course but the systems are yet so immature to warrant the current mandates.
We adopted electronic billing in my private practice in 1993. It worked great. Minimal investment and hardware update after 6 years. That was a wise use of computers...cash flow.
Thanks Dan, for putting it together for us. I appreciate the research and thought you have put into this. Also, its great to finally hear something positive.
Dan, profound and insightful. You have identified and elucidated the problems, now it is time to take the next step. Every revolution needs a leader. You have the platform. Use it.
I do not believe the AMA will have any kind of credibility without physician involvement;'patients' are much more evolved than was the case.The cat will be out of the bag,so to speak.They will stand starkly as a corporation that sells codes and insurance.Physians remain their main customers,even if they take on non-physicians.The only way they can pull it off is IF, as has happened before,physicians collaborate.
So far,their perceived political stance is based on the public assumption that most physicians are on board.If they lose that appearance,the deception will be over.They are welcome to try.These little matters become apparent in conversations with patients;they(patients/consumers) remain in the dark.
Dan: I think the pain has just begun... I'm not so optimistic about AMA. I think AMA will probably lose relevance if the government usurps the CPT coding or brings out some other variation like bundled payment for services( episode of care model). The employed physicians still need to wake up. Their party will be soon over with their jobs earning slightly less than a PA's take home pay( already the norm here in Columbia, SC for pediatricians). Community hospitals will be largely staffed by NP and PA types with a figurehead "Physician Leader" and lot of clipboard staff for ensuring compliance. Physicians working on short term contract for services will be more common. University docs will be doing less frequent talking circuits and be more at their jobs generating income. Costs at out patient centers for surgical services will drop steeply as the insurance companies will have powerful leverage under the new rules..By late 2010, before next year's contracts are due, I expect to see more of a take it or leave it attitude from BCBS and similar companies. Job losses will be massive by mid 2010, no matter what the government statisticians are telling you now. There will be a significant drop in stock market by Sept 2010. Let us see how this goes....
MA Senate bill #2170 seems short and to the point: if you practice within the Commonwealth, you must accept the plan, which reimburses 110% of Medicare. But the last section of the bill is confusing: Section 1 of this act shall be repealed upon such date determined by the Commissioner that a common payment methodology has been implemented across all public and private payers across the commonwealth. Is Single Payer anticipated to the point that it's being written into law as a contingency?
Keep your debt low and your lives simple. Keep your practice overhead as low as humanly possible. Cherish the physician-patient bond. Differentiate yourselves from the "providers" by demonstrating your knowledge and professionalism. Try to tune out everything but the patients and their needs. Everything will be OK in the end.
I think things will continue to get worse until we take a stand. The problem is that currently so many physicians are in the dark and have no idea what is comming. I do not think they will be ready to take a stand until it is too late.
Thanks for the post, Dan. When I woke up this morning, I felt like crying because of the overwhelming sense of loss I feel about my profession being hijacked by beaureaucrats. Your optimism is contagious.
Sadly I have to agree with Sermo Doc 11, the majority of our brethren are clueless, being let like calves to the slaughter,
excellent post Dan, can you get this in the WSJ or NY Times and other major newspapers. Send it to Glenn Beck, he'll read it onair or post it on his wweb
Sermo Doc 10 says..".Keep your debt low and your lives simple. Keep your practice overhead as low as humanly possible. Cherish the physician-patient bond. Differentiate yourselves from the "providers" by demonstrating your knowledge and professionalism."
That first portion is excellent advice for everyone, but, the last line..."Try to tune out everything but the patients and their needs. Everything will be OK in the end." is very dangerous advice. We all owe it to ourselves and to our profession to stand up for what is right and defeat this corrupt nonsense. Tuning out is not the answer.
Economy lost **another** 85 K jobs in December - yes, economically the most active month of the year. If it were not for regulations crushing me, it would have been only 84,999 jobs lost. I decided to let go of my hired-but-yet-not-started employee as I am not too hopeful of the changes coming and doubt I can afford not to keep tight leash on overheads. Passage of senate bill changed the equation for me. Now, I am actively seeking ways and making plans to shut down my practice.
SERMO docs have been absolutely right on everything including the dire economic projections, practice issues, policy and what influences it.
SERMO is the single most important repository of common sense, if only the politicians care to seek unvarnished advice.
NO doctor will shed a tear at the demie of AMA, except perhaps the AMA employed, generally not practice worthy docs.
One trend which is almost certain is disappearance of independent practices and expansion of large corporation run practices. Quality of care that pt will get will be very different than they are used to - with biggest difference in "customer care" aspects.
One example will suffice to highlight the difference. I used to work in employed setting with a large regional Kaiser like HMO run practice. In my 3 years with them, there were 3 instances when pt could reach me after hours. In my current private practice, pt have my personal cell phone number.
Probably, pt will get used to it. As such pt have very little control over quality and value of their money in current system. It will be drastically down to almost zero when reform and other changes are finalized. They will pay what Govt/Ins co demand in form of taxes and insurance premium and they will get what Govt/Ins co/corporations decide.
I guess, they will get what they deserve. Pt are so full of entitlementisis and have not taken any active role in influencing any control of value of their money.
Other highly likely trend is significant drop in quality of medical school entrants. We can track their pre-med school exams performance scores and objectively assess the change.
Does anyone have more info on Gen-A(www.generationamerica.org)??
Came across a radio ad a few weeks ago with a statement:"circumvent government healthcare" Just looked at their site last night;they seem to represent everything most here are for and against.Cost to join is $19.00.If a large number of SERMO members join,it would for a formidable voting block in 2010.Just not sure what the pros and cons of joining are yet.
took a look at Gen A site. They plan to broker medicare advantage policies! To me, it looks like another group of work-from-your-garage enterprise trying to sell insurance and bring customers to businesses. ...... perhaps a grp focusing on baby boomers trying to unite them to get more free goodies.
The AAPI ( association of physicians of Indian Origin) is lobbying congress for allowing Indian Graduaes to enter US for PGY-I position on H1B visas with less hassles! This will be the last straw on US graduates back. Anyone foolish enough to go to med school in the US will be saddled with unpayable debts. This will essentially kill the Graduate medical education as we know it. I am surprised that lobbyists can override ACGME!
AAPI is assuming Indian grads will be willing to come here? I am finding it difficult to believe the old time adage "Once here, here forever". Talk of going back is getting more and more common. Malpractice stress and visa retrogression being the big issues. India is the biggest source of FMGs. Let dollar come to its real value and equation changes dramatically. May be we will get some FMGs to come, but again, quality may change significantly. May be, they (BO & co) have anticipated it and have proposed a bill that Indian doctors will not be subject to green card cap any more. Perhaps, down the road, they may even eliminate need to do PG training here and all Indian doctors will get a license to practice in US with mere passing of USMLE.
Thanks Dr President:, wholeheartedly agree with your predictions!
What SERMO has initiated is a voice that reverberates to patients and nonmember physicians are either aroused with enthusiasm or curiosity to join the bandwagon!
The SERMO initiative needs to be continued with greater momentum and change for a higher level of professionalism, respect, camaraderie and collegiality among members !
Disagreement should always be constructive that exalts the integrity of the medical profession as observed from the "outside online lookers" .... and not hitting below the belt!
Its been encouraging to appreciate sincerest, honest thoughts of colleagues and majority I believe had been commendable and been very proud of!
Agree with the above, in most SERMO doctors attitude of tolerance and flexibility in facing the current health care change (onslaught) with the view that majority of us will not be coerced thru political expediency and AMA "submission!'.
On the other hand, positive innovations, respect and dignity of the profession is upheld thru AMA "purging' and DC political bullying!
Under your leadership, 2010 will be very exciting and the face of health care will definitely purge the medical structure because of AMA failure to uphold the dignity and integrity of the profession.
The positive change will redound to increase both in quality and quantity of SERMO doctors being in the affront of health care both in pt-physician relationship and national representation!
Thanks for the utmost opportunity to share and see your invaluable but very productive leadership!
Im not optimistic about my future here in massachusetts.Im really considering my options for an exit out of this state.Main concern is where to go......is the grass greener,and what practice model to involve myself with?Life seems hard now.....Im resentfulI feel contempt for the people .processes that are occurring now.I feel trapped.Sermo has been good.Feed back great.But still our profession has no powerful organization that stand for us and thats what we need.
I can't wait until the 40 million uninsured start showing up in the ED after insurance reform, when they can't get in to see their PCP. It's going to get ugly, IMHO.
I agree with your statements. However, as more physicians in practice close their doors to third party payers, more patients will be using the emergency deparment as a source of primary care. Watch and see what the price of medical care will become then...!
A physician class action suit against the AMA would be newsworthy and, if nothing else, inform the public and ignorant politicians that the AMA does not represent most physicians. An AMA endorsement will cease to be meaningful. Other means to achieve the same ends would be just as good.
To add fuel to the fire: The insurance administration in New Mexico has issued a memo that eliminates corporations from the state liability cap. That would mean that the limitations in payout would apply only to individuals, but your company can be sued for any amount. Some communities have issued restraining order to stop this from going into effect for the time being. It seems from the press that everyone agrees, both Rep's & Dem's, that defensive medicine needs to be addressed, yet no one will actually do it. Are doctors doomed to be litigated out of existence, or will someone rescue Americans from legalized greed?
Sermo Doc 14 - in recent threads you were very optimistic, have detailed your hyper efficient office system. What has specifically happened that you are now planning on closing? I had thoughts of contacting you to try to emulate your formula. Now I'm very discouraged.
I'm glad for the optimism. Right now I am just devastated by the changes. The end of consult codes is very devastating for endocrinologists. If I was done paying off my student loans, I would not feel as bad. That's my only debt! I have lived so frugally in order to save and invest and be debt free and because I want a great education for my child. So all of the sacrifices that I have made mean nothing right now. I delayed fertility for my profession. Thank God I have a beautiful 2 year old son, but he will be an only son because I recently lost a baby after 3 weeks in the NICU (he was born premature at 28 weeks b/c/o plancenta abruption). I keep thinking that if I had chosen another profession and had children before the age of 35, that may not have been the case. For my sacrifice, I feel like the envy of the ignorant public fueling the greediness and power hunger of politicians is out to destroy our profession, our prestige, our hard work. As you can see, I am in a very negative state of mind. I'm glad to have read something that has a positive outlook.
The self employed MD who is seeing a post operative wound care patient is not reimbursed because the medical problem falls under post operative global care. The same doctor working for the hospital cannot bill for the wound care or the bandage supplies but if he sees the same patient in the hospital clinic the hospital collects $300 facility fee and additional supply fees. Moral of the story; If self employed docs cannot take care of medicare patients in their office the government will pay 6 fold for the same care delivered by same doctor now closing his office and now working for the hospital. Penny wise--pound foolish.
Let's put some skin in the game;talk is boring,tedious and cheap.Whatever we intend to do,i.e.sue the AMA,form a new organization to represent practicing physicians,etc.,will cost money,lots of it.Let me know when we get tired of micturition al-fresco;I'll be the first to send my $1000 cheque to sermo.I'm outta here.
Post-operative global care applies only to the operating surgeon or whoever performed the procedure. If someone else sees them, they can charge for the visit.
My predictions is that docs will most definitely not stop playing, or actually being, the victims in 2010. Rather, I think that paperwork and legal liability will increase, overhead will increase dramatically, re-imbursement will decrease, for the foreseeable future.
Sermo Doc 29: Sorry for your loss. That is a poignant story. No amount of planning nd commonsense can make up for the lack of the same stuff in national policy makers.
Just curious - Any people here who can defend the actions/purpose of the AMA? I don't have any deranged hatred of the group or anything...just curious because it has been years since I ran across anyone who belonged to the group.
Duh, hello. What does everyone think this has all been about anyway?
The entire drift is to make physicians government employees. Has been for years.
Answer: Unionize and go out on strike
Until enough of us unite in opposition of this government imposition, we'll increasingly become their employees. Insurance companies owe it to their share holders (and own bonuses) to fall in line with these reduced Medicare payments to maintain their margins. Pharma and BioTech have already cut their deals. NO ONE has stood up for us. The AMA is a joke. We need to organize, oppose and persist for our own rights. Any one interested? Email me at Sermo Doc 37@urosurgeryhouston.com.
Good work, Dan. Congress current alleged "healthcare reform" legislation may well be the "straw that broke the camel's back," ushering in a new golden age of independent practice. Some simple facts (at least in my limited experience doing primary care in a small town): 1. I'm in the process of exiting Medicaid, and have noticed that many aspiring new patients, when told I no longer take Medicaid, choose to pay may fee and see me anyway. Fact is: most Medicaid patients can afford cell phones, gasoline, cigarettes, cable TV AND $100 to see the doctor every month or two. 2. Many Medicare patients care more about the quality of their doctor than about who pays for the visit, and can afford to pay $100 to see the doctor every month or two. 3. Most patients who need to pay a Sermo Doc 33 a $2500 fee to have their appendix or gallbladder removed or a hernia repaired can put it on their credit card or get a relative to help them pay for it. 4. Most of us can make an excellent living collecting $100 per visit, as long as we're not squandering half our time and $100,000 per year futzing with CPT/ICD codes and jumping through Medicare/insurance hoops. 5. It is both unethical and inefficient for patients or physicians to allow third parties to insinuate themselves into the patient-physician relationship. 6. An efficient healthcare economy CAN ONLY RESULT from patients and physicians negotiating services and fees DIRECTLY WITH EACH OTHER, as occurs in all other segments of the economy. 7. The only valid purpose of insurance it to protect against catastrophes. Once doctors begin to behave in an economically enlightened manner, maybe patients and Congress will too. Dan Jones, MD www.JonesPlan.BlogSpot.com
Dan, yes, docs will opt out/are opting out but i don't see that we have done the job we need to counter the perception that docs are richly reimbursed. So when your medicare patients cannot find a participating physician, you seem to think that they will align with us to demand the system will be fixed. i wish i could be as optimistic but i don't see them doing anything but demand that the government fix it which it will do by tying our licensure to acceptance of these programs. And that doesn't even count those docs who are actually surviving on medicare as it pays better than other insurances. Once insurance is mandated, as it seems it will be, then the next logical step is to mandate access to health care. i predict they will do that just as in MA. So then what do we do, emigrate en masse to another country? Join the others in the unemployment line? i think not. And you're several years behind in your prediction of what the AMA will do; the train has already left the track. If you think it's been advocating for docs these past few years, i've got land i wanna sell ya! Unfortunately, i agree with Sermo Doc 33; it looks grim for the foreseeable future. But overall, i love medicine and have great hopes for its future despite these terrible things. The youngest MDs will adapt but i feel great pity for the middle MDs who cannot easily change course/too young to retire. What do i think is the best course for the average MD? Don't waste the time fighting, i think the die is already cast. Get smart and try not to capsize in the big waves and always, always, always care for the patient. It's not tuning out, it's being realistic.
Are there any ideas on something proactive that we can come together to do? I know we all want something to be done but I don't think anyone knows where to start, things are such a mess. I just feel like I want out at this point, but with loads of school loans it's difficult.
WE MUST STOP the INDEPENDENT PAYMENT ADVISORY BOARD (formerly IMAC) NOW!!!!
Please Email Your Representatives in Congress and Ask Them to Sign The Neal Letter Stating They Will Not Support Any Healthcare Reform Bill that Contains This Provision!!!
The AUA needs your help! Please ask your Representative to sign a letter being circulated by Rep. Richard Neal (D-MA), which expresses strong opposition to the creation of an Independent Medicare Advisory Board (IMAB)---the unelected, unaccountable Medicare payment policy board which would potentially have unilateral power to change Medicare payment and policy without Congressional oversight. This proposed board would replace the current Medicare Payment Advisory Commission (MedPAC), which serves solely as an advisory group to Congress.
In late December, 69 members of the House of Representatives joined together to send a letter to Speaker Nancy Pelosi (D-CA) clearly stating their strong opposition to any proposal that would divest Congress of its authority for Medicare payment policy and place this responsibility in an executive branch commission or board. Because of such a strong response, Rep. Neal is providing an opportunity for House members to add their names to this important letter.
While the House-passed health reform bill, the "Affordable Health Care for America Act" (H.R. 3962), did not include provisions to create such a Medicare board, the Senate-passed bill, the "Patient Protection and Affordable Care Act of 2009" (H.R. 3590), does include provisions that would create such a Medicare payment policy board, which would be called the "Independent Payment Advisory Board" (IPAB). The creation of IPAB would effectively end Congress' authority over Medicare payment policy and would also empower this board to make policy recommendations regarding health care provided in private, non-government health care settings as well. Placing such important decisions in the hands of a commission without appropriate checks and balances in Washington could have a far-reaching adverse impact, not only for Medicare beneficiaries, but for all Americans' ability to access quality surgical care in their communities.
We need your help in letting Congress know that urology opposes these proposals to create such a payment policy board.
Tom- I was not particularly optimistic. I was just showing way to reduce pain. With each day, things are changing for the worse. I got a notice from local IPA that they will not be paying for level 4 service anymore. Medicare consult code elimination is a non-event in my town. Even with my low overhead model, there are issues that are not addressed to optimal level like sexual harassment issue. There are other issues that I just do not have good answer for like what if down the road ins co decides that coding was wrong. What do I do? Go to court? for 10 dollar? They know weakness of small practices. Pt dont care. They would rather spend money on nail spa than on their health.
Sermo Doc 37, I agree with everything you say, especially that we need to organize more/better. The AAPS (American Association of Physician and Surgeons, www.aapsonline.org) seems to be standing up for us, and I encourage you to consider membership. Also, maybe Dan Palestant would consider adding a "Patient-Doctor Advocacy" section to Sermo. I for one, and I suspect many of us, would be willing to contribute financially to a program of targeted lobbying and advertising to fight the lunacy being imposed in American healthcare by the federal government. Are you listening, Dan? Daniel Jones www.JonesPlan.BlogSpot.com
I agree with much of what has been said, including supporting a targeted effort to advertise and lobby to fight the current government healthcare mess. I too feel like I want out...but also have student loans that are prohibitive. I think we need to fight the out-dated public perception that we're all rich and any time we complain about what's being done it's just because we're "greedy". I do what I can to educate people, but I think it's a bigger job than an individual can do, and the AMA has not been doing it either.
Some comments I *entirely* agree with and that I feel need to be emphasized:
It is both unethical and inefficient for patients or physicians to allow third parties to insinuate themselves into the patient-physician relationship.
An efficient healthcare economy CAN ONLY RESULT from patients and physicians negotiating services and fees DIRECTLY WITH EACH OTHER, as occurs in all other segments of the economy.
The only valid purpose of insurance it to protect against catastrophes. Once doctors begin to behave in an economically enlightened manner, maybe patients and Congress will too.
Today I spent some time discussing what is occurring with this "reform" process with our office manager who is a very sharp nurse practitioner who decided to move into medical management and does quite well. She was horrified with what is occurring and was not aware that Harry Reid and Nancy Pelosi have maneuvered around the normal conference committee process to continue to craft a bill in private with Rahm Emmanuel. Think of it...these three politician/attorneys are working in secret on the largest change in American health care since 1965. I had to sit down and quiet down...I was so angry. Are we really in America? This is beyond serious.
Sermo Doc 14,
Is FUKITOL over-the-counter or by Rx...sounds like something we could all use once in a while! Maybe it'll warm you up there in Florida! :-)
Isledoc-- There is Fukitol CR which is still branded, and Fukitol generic which goes by the generic name coitus totus. I personally prefer the Fukitol IR (instant release) for those moments that cause me to break another molar.
As a government employee, it affords me amazing benefits barely imaginable to private practice which include paid days off, paid sick days off, paid holidays, access to government employee programs. There are programs for purchasing and improving housing and all kinds of amazing add ons.
All Physicians in Mass all of the sudden qualify for the same benefits. They need to class action sue the Mass government as they are unfairly excluded from rights of government employees by incorrectly stating that they are consultants. By definition, consultants have a choice of whether they work for the government, whereas state employees do not. So, not granting those physicians state benefits, is a federal labor law violation. I am not a lawyer, but I may become one... Anyways, those docs are some lucky folks.
Your three major issues galvanizing physicians and your four predictions are refreshingly candid and accurate compared to the AARP and eAMA Newsletters and their cynical, and probably likely to fail, back-room dealings with Congress.
If, as was revealed in Massachusetts Senate bill #2170, the state Health Insurance Commissioner actually now has the power to implement a "common payment methodology across all public and private payers across the Commonwealth" , the only practical response of self-employed, office-based MA physicians is to organize and create multiple multi-specialty single tax ID group practices throughout the state.
Maybe the more than 500 IPAs and over 200,000 doctor members of the 16-year-old IPA Association of America (http://www.tipaaa.com) could become the catalyst for such a proactive business model transformation.
By the way - due the loss of consultation codes, our first business moves were - not replace staff member lost due to attrition (1 job out of the millions lost) And we are reducing time spent on new patients to 30 minutes (was giving beyond that to push quality). So much for job creation and quality affordable health care.
Dan, glad you are feeling optimistic, and Sermo is a great place. I'd love to join a suit against AMA. I think it would be good publicity for docs, definitely get in the papers, and start to fight back against lies and corruption.
Does seem like more chaos is coming, however, and what the outcome of all that will be is not at all clear.
Well said, Dan. I'm so sick of doctors being portrayed as money hungry. American people need to realize that we are not the enemy; congress, lawyers, and insurance companies are!
I'm money hungry. Very money hungry, in fact. I want to make enough money so that I could work less and be home every day at 5 pm. So that I can spend more time with my wife and our son.
Doctor Bashir; well said. I work very hard; and expect to be compensated for my time. It is an acceptable statement to make in any profession but not in our own for some reason. They can all lick me where I ***. Work hard; play harder. I will NEVER change that mindset. Sooner or later they will have no choice but to play by our rules. You get what you pay for. SOoner or later; everyone pays. I too; will be licking my chops.
Done. I have been upset all day after I got this letter from the local IPA telling that they will not pay for 99244, 99204 and 99214 and will pay only for corresponding level 3 when these are billed. It is unilateral, arbitrary and has nothing to do with patient care but is just an extortion and stealing of services. After hours of thought, I have decided to send my termination notice first thing in the morning. Its not worth it. I did not sacrifice 15 yrs of my prime of life to have the privilege of taking this bullshit. Their actions do not help me take better care of my pt. I can not tell my pt that I am not allowed to provide more than a certain amount of service. I am done with this IPA. I will make less but I will sleep better and have my dignity and conscience intact. I am relieved.
Any tips what not to do what to do in term letter? This is my first. Today, I complete 6 months of my practice opening.
This year also we will see the whole media talking about mid-term elections and the Republicans gaining seats in Congress.
But don't get excited folks, we already had a majority in the house and senate, a republican president, a doctor (Bill Frist) as senate majority leader and nothing good happened for us or healthcare, including Tort Reform. Some republicans even voted against tort reform and some didn't show to vote.
So not trying to be pessimistic, but I just don't any doctor wasting his or her energy or get distracted with this presumed takeover of Congress and false hopes, but rather channel the time and energy as Dr. Palestrant illustrates in this article, including dropping Medicare if necessary, etc... and fight the wright war.
Sermo Doc 14, I think you should say this: "It is unilateral, arbitrary and has nothing to do with patient care but is just an extortion and stealing of services. "
Spending the necessary time with patients is not wrong; it is not wasteful; there are times when it is needed, and we all deserve commensurate compensation.
Toasting you with a glass of Autonomy as I swallow my Fukitol IR
I would be happy to participate in a plan for Medicaid that reimbursed 110% of Medicare. Unfortunately in my state (IN) the reimbursement is usually less than 40% of Medicare making it an untenable situation. We have very few docs accepting Medicaid now.
I predict that no matter what the cuts we as doctors see - loss of consultations, 21% cut, increased time wasted on RAC and CERT, WE as doctors will simply bend over and take it & not change a thing at all.
I predict that most doctors will be the same business idiots we always are and simply do the same exact thing that we always do and for some retarded reason expect that doing the same thing over and over again will somehow, someway, by some miracle of divine intervention result in a different and better result.
yes, MM thats what I meant to say. I was too upset to be coherent. Thanks
BTW, what I am sending them is a suppository form of Fukitol.
After I am gone, their network will have only 1 Endocrine and he is not much liked around here. Ins co cease to exist if they dont have enough doctors in their network. I can find other ways to survive.
Well said, Dr. Palestrant. I appreciate all you have done for sermo and us physicians. With the AMA and the corruption seen so often in healthcare, it is really nice to know that there is a collection of physicians who can and likely will make a difference in the right direction for healthcare.
Sermo Doc 14 - if these level 4 codes become non-covered services then you can charge the patient directly. Basically the 3rd party payer will not pay for a new patient exam or new patient consultation [just skip the confusion of a return patient complex]. So this becomes an easy explanation to patients - if you haven't seen them before, they need to pay you up front your "first visit to get into my practice" fee. Not the differential between the 3 and the 4 (probably fraud) but the actual full fee.
Things will get worse before better. Primary care will lead the way, specialists will have to figure out their own routes. But primary care will be the element that corrects the patient/physician relationship. Thanks to you all and blessings.
When you terminate with the IPA, send them an Rx for FUKITOL and ask for payment in full or else they'll hear from your attorney!
You're a good Doctor...we need more like you to speak out and change the system!
"... whenever the Legislators endeavour to take away, and destroy the Property of the People, or to reduce them to Slavery under Arbitrary Power, they put themselves into a state of War with the People, who are thereupon absolved from any farther Obedience, and are left to the common refuge which God hath provided for all men against force and violence. ... [Power then] devolves to the People, who have a Right to resume their original Liberty, and, by the Establishment of a new Legislative (such as they shall think fit) provide for their own Safety and Security, which is the end for which they are in Society."
John Locke
No, they are not calling it non-covered. they will just pay for level 3. If I want to protest, I can send the notes and they will review it and after a few months, will say that it did not meet criteria for level 4.
If I could charge pt (even 20% of them), I would never sign any contract. My practice is new and my area is high poverty rate area.
Dropping out this insurance may turn off many referral sources. But, I can not afford to have my BP go up like it did yesterday. I will live with few thousand less.
The MAJOR problem as I see it is that our medical licenses will at some point be tied to participation in state/federal/other future govt plans. We will be held hostage. This will cause a major efflux of physicians from the U.S. and a mojor decrease in influx of physicans to the U.S. Don't forget we had doctor patient relationships long before third party payors and other countries function without them. This will lead to a significant reduction in ACCESS, a problem we didn't have before. They will have suceeeded in turning a health insurance problem into a health access problem. I have not seen any of us turn away NEEDED health care to an indigent.
Have to get me some of this FUKITOL.Orlando,can you call it in to my pharmacy without a so-called,good-will physical examination?Is it scheduled?Generic is fine:~)
Dan and Sermo Doc 1 you are right on.
However, Dan, I believe that you have missed the progressive's " final solution," and that is to outlaw private practices......or tax them out of existence.
I, like many of you, have been facing a connundrum. Like most of you, I cannot make a living anymore as a solo primary care physician, not with 21.5% pay cuts, and no increase in reimbursement while expenses keep rising. However, solutions offered here the last few days all have problems. Quit medicaire and insurance, and go cash only--- and I believe you can only serve 10 - 15 % of your existing patients. So 85-90% are stuck looking for care (not good). Legislation may require you to participate in state run plans as they have in Mass. so even the cash model may falter soon anyhow (not good). Go into some other line of work?--what else are we trained for?. (not good)
For now anyhow, my plan is to continue seeing patients in medicare if congress ultimately fixes the formula. ( one can hope, at least)
If they don't, this FP will have to quit all plans and "go concierge".
Instead of my current patient population of patients and going broke, I've already calculated, I can charge $1000 per year, and easily provide the same level of care I do now, as long as 500 patients take me up on it. The reduced expense of such a small patient group, (even though they may be more demanding folks), includes reducing office size, staff down to ONE assistant, and a life devoid of 70 hour work weeks. In fact, my estimate is this will double my take home pay!!!
So, I could do this untill the gov't outlaws it too.
Though I'd be bored with the short easy days, and feal bad for the patients I'd have to leave behind.
I JUST DON'T KNOW IF I HAVE THE KISHKAS (guts) TO DO IT.
Doctors are not capable of working together------we are selected and TRAINED to be independent thinkers and not trusting of others----Have you ever relied on someone else's exam instead of doing your own--for example ! No----the picture is not rosey. American medicine is currently the best on the planet---- but our healthcare system to deliver this medicine can only be described as a major CLUSTERF@#@-----and we are partly to blame. We treat disease [ because one makes more money doing procedures and treating people ]------we don't prevent disease. Attorney's { who write the laws of our country} fly like buzzards over us to enrich themselves when we treat too much or make a judgement error. Medicine should not be ---and never should have been a "for profit entity". Our system today is just like a uesd car-----patched up over and over again---and still running poorly. It's about tmie we scrap the whole system----I mean from top to bottom-----we need to rebuild it ---not patch it up. Select p-roper people to practice it [ not just high achievers ]-----have the public pay for the education as IT WILL BE SOCIALIZED------rid ourselves of the legal scum that haunts us now------but foremost stop reimbursing procedures so well --train doctors to recognize and prevent disease--instead of just treating what we stumble upon [ hell- today if we find a drug that will treat something that doesn't even exist--we make up a disease like "restless legs" [LOL]-----we are so i9nto treating and making money doing it! The whole system needs to be scrapped------it's rotten in every corner! Just like the used car----there comes a time when you just have to bite the bullet a find a new one or build a new one...The time is now.!!!!
Prediction for 2010-------SSDY. Same S@#$ Different Year. As stated above we need a revolution [of sorts ]. Medicine will be socialized----America will eventually catch up with the rest of the world {it could take awhile---look how long we've held out against the metric system}. In the process of being socialized maybe we can learn to work together to build a better system .Come on now------doctors in other more progressive countries are not starving . Maybe they are not obnoxiously wealthy , and maybe they don't do as many needless procedures----- but they still practice medicine , and work towards a healthier population. If this doesn't ring true----then you went into medicine for all the wrong reasons. Accept reality----American medicine will eventually be socialized.And if the current fundalmentalist mindset won't practice in that setting-------then fine-----the country will find others that will. You know----We can be replaced.
Colt Python!!! I haven't seen one of those for sale in years. An absolutely classic well made revolver. Ak4700, do you know where I might find a 4inch nickel? I'll settle for blued if it is still at least 95% from holster wear.
Sermo Doc 61--ak4700 is an ok guy, you will see with time. Guns are not the root of all evil. Evil is the root of evil. Guns will allow my 120# wife to protect herself from a 290# bad guy. Some folks recognize guns are not the problem. Misuse of guns, or worse, the arbitrary and inappropriate restriction of guns, is the problem. The swiss are an excellent example of guns, law, and order. If they all die off and leave me in charge, I will issue guns to everyone. They will be available to protect themselves, to hunt and to keep their freedom from me if I should decide I am the messiah.
2009 was my first year in a cash only, no insurance practice. I opted out of Medicare and cancelled all my insurance contracts at the end of 2008. It was the best decision I ever could have made.
My first year in this model was better than any other year in many ways:
I am seeing fewer patients per day. I allow myself more time with each patient. I allow myself a full one hour break during the day (I was never able to do that when I accepted insurance). Patient care has improved--I am coordinating care with other doctors much more effectively. My case load has gotten smaller, and so I get fewer after hours calls. Patient attitude is different--they take their health much more seriously when they are the ones paying for the appointment. I can get patients in for a follow up appt the same day, or at least within 1-2 days. I have a much better attitude at work because I KNOW that I am getting paid for each and every appointment. If I decide to take on a charity case, it is MY choice. I feel like I am practicing medicine the way it is meant to be practiced. I no longer have to pay a billing service to submit claims for me. My gross practice income and my salary INCREASED this year. I am happier and my family life is much improved.
It was a scary step to take, but opting out of Medicare and converting to a cash practice is a very realistic option. I believe it is not just unique to my specialty, either. I think just about any doc with an outpatient practice could make this option work...provided that your neighborhood isn't flooded with docs in your specialty. If you provide quality care, your patients will be willing to pay for it.
For years, ever since I stepped into USA as an FMG in 1994, I have seen this writing on the wall. Better late than never, I developed a plan for myself, when others laughed at me. I slogged through my MBA and developed a plan B for myself and my family.
For each and every one of you physicians out there, get your heads out of the sand - The reality is that there will be significant upheaval in our practice models, legal atmosphere and economy. By the time the dust settles, it would be a significant time you lost in your life - may be next 5 -10 years.
You will never regain the fee for service model from 1950s unless you stand up and do something about it. The first thing you should do is to liberate yourself from dependency on your physician career. Then you will have the clout to say and get what you want.
Please get into an alternative career along with being a physician - get into real estate, get into software development, get into healthcare administration (where you can make millions in salary for 9-5 jobs for 5 days a week and no pager).
But never give up....
By the way, Texas enacted tort reform only when the bow was about to break. 5 -6 yrs ago every one was running away from TX because of bad malpractice hellholes there. Expect the same nationwide. The only time when the whole nation will streamline its interests and want to follow the right path and truth is when cataclysms occur. Otherwise, democracy will continue to pit 49% against 51%.
I am concerned about rumors I read in newspapers about the bully politics the Democrats in particular Rahm Emanuel, David Axelrod etc in Obama administration are running. If this is true, they are systematically bullying any voice of opposition using any or all means at their disposal. I just hope this is not true. Many physician colleagues have told me that they are afraid to stand up in their respective national associations because they feel they will be persecuted by the current administration.
chraka is right. Although most docs see the looming problem clearly, they try to swim with the masses...It is time to really take a hard look at what you do everyday to earn your living, how you plan to be able to feed your family when things fail in the third party system over the next 4 years. It will be survival of the smartest! A competition the likes of which is often not encouraged or seen in the US education system or business.
Sermo Doc 23------Save your "canned speech "for someone else---did you read my post--I am I hunter,I have all sorts of weapons, I reload all my own ammo--although now I hunt exclusively with blackpowder flintlocks------ but I don't wear my gun ownership like a badge---No you can't have my pristine Python--the finest commercial handgun ever made. But bear with me----the more we throw our guns in peoples faces the sooner we will lose the right to own them.I don't believe in god either---but I don't have a blog name like AtheistMD---it's a sensitive subject---not for me --but for the rest of America--just like guns-----just like the inevitable socialization of medicine. I was commenting on ak47's general mindset-----that's all.And he thinks I'm infantile!!!
If I try to see physician career as a business from Buffet's point of view, I see that one fundamental trait of this "business" is a very adverse aspect - dependence on 3rd party payment system.
As long as we can not function independent of it, we will always be subject to unilateral, random rules and unfunded mandates which may not have anything to do with improving quality of care and may cost us more money. Such things will keep adding to our frustration and will take increasing amount of our time away from patient care.
I was hoping that we may devolve into direct service - direct pay system but now that chatter of tying license to accepting GovCare and expansion of entitlement program in healthcare is getting louder, I am scratching my head to find a complete exit plan.
No matter how much I like getting diabetes under control, I can not do it at complete annihilation of my personal life.
As I've said so often here, would love to be in a cash practice.
I think it may be a little easier in Psychiatry. A friend stopped practicing for a year when his wife died. He reopened his Pyschiatric practice and sublet space from another psychiastrist. My friend does cash only, $50 for a half hour. He did it just to keep busy and thought he would probably make a little money. Just working two days a week.
he is now very busy, very happy, doing very well with cash only on a low fee!!!
Unfortunately, we are in debt and old docs and just can'[t get out of it right now. Wish we had another income stream.
Sermo Doc 61 relax.What's in a name?Let alone a blog name.Does Sermo Doc 61 represent your "mind set"?Lets not make a mountain out of an anthill or disrupt the relevant topic at hand.Enjoy the day.Regards, ak;~) Firedoc,try the internet for what you seek.
The specter of Obamacare has at least woken us up. 2010 will be a crucial turning point. WHAT TO DO? Right now, you can donate to Scott Brown's campaign. He is the republican candidate in Mass. seeking Ted Kennedy's vacated seat in the special election to be held on Jan. 19. (Hence the push to "pass something" before OB's State of the Union address which might be on Jan. 20).
See the letter below from Docs4PatientCare and Scott Brown's websit for details. If everyone above sent in even $50 it would be a big help. I live in Michigan and just sent in a donation. This particular race is not just about Massachusetts!!! Bill Clinton himself is scheduled to appear to support the Dem candidate. But wouldn't it be great if the demise of this very bad "healthcare" bill came about as a result of the replacement for TK's seat?!!!
Dear Doc 4 Patient Care Member
There is a special election on January 19 in Massachusetts for the vacated Senate seat. Scott Brown is the Republican candidate running for that seat. He is on record as stating that he will vote against the Healthcare Bill. He would be the 41st vote and would enable the Republicans to filibuster this bill. This is a Hail Mary pass. It would be a miracle if he won Ted Kennedy's seat. However he was 19 points behind several weeks ago, and is closing. He now is in a statistical dead heat according to one poll today. The polling data assumes that people will show up at the poles to vote. A snowstorm or inclement weather will keep people away. Anything can happen.
The people in the leadership of Docs 4 Patient Care have all personally supported the Brown campaign. We have donated money which he needs to keep the pressure on. I would urge every person receiving this email to go to Scott Brown's web site (http://www.brownforussenate.com/) and give a generous contribution.
This may be our best shot; our only shot to stop this horrendous bill, which we all know will change medicine for the worse for us, our families and for our patients.
Good luck to Scott Brown and to all of us.
Hal
Hal Scherz MD
President & Founder, Docs 4 Patient Care
Sermo Doc 64, I am also in Michigan and have recieved the same letter from Hal. I am also supporting Scott Brown's campaign. If he wins it would send a very clear message that would be difficult to ignore....America is not with you, Mr. President.
Like everyone else, I am hopeful that Scott Brown will win and vote against the health reform bill. However, if you go to Boston herald.com. There is an article titled Senate can stall winner's start. The articles states that even if Scott Brown wins on Jan. 19 , the democrats/senate will stall his being sworn in, leaving the incumbent Paul Kirk (who is subbing for Kennedy) to vote for the health reform bill- he has stated very explicitly that he will be following Kennedy's legacy and will vote for the bill. I cannot believe this! How can the democrats blatantly go against the will of the people in Massachusetts--this should be considered unconstitutional! Arrrggghhhh! The Crats wheeling and dealing are getting out of hand. Everyone should buy a copy of Michelle Malkins which exposes the corruption in this current government.
There is hope for Scott Brown but he is up against a very powerful Democrat machine in Mass. like that in Chicago...I'll support him but won't bet the farm!
As history has demonstrated over & over, socialism (as an economic entity) is not sustainable. So, for the business of medicine, if you want it to be less economically viable and economically forever dependent on financial "prop-ups", then we should socialize it. If you want to encourage a potentially self-sustaining model, then a system which maximizes choices, rewards innovation and superior service, and provides a mechanism of accountability for consumers and providers, then for-profit medicine (i.e. capitalism) is most likely to succeed. I agree w/ Sermo Doc 61 that this country is certainly no longer as free as it was; socialism's inroads are what have largely taken freedoms away and will continue to do so if we let it.
It is not immoral to make a profit for providing a quality product. Criminy, you will die from lack of food much more quickly than you die from lack of health care coverage, but nobody is calling grocers immoral, avaricious, greedy, etc., or trying to socialize the grocery industry. Unsafe cars can kill people as quickly as unsafe medicine, but are we socializing the auto industry? Oops, my bad...
I just donated to Mr. Brown. We have got to wake up and donate to all that are on our side. We are awash with stupid democrats who are sold to special interest. I have worked my ass and my pocketbook off with donations this year. If we all did we would be in a better position.
the boomer docs are planning to exit earlier especially if medicare dependent better to retire than to go broke working some have gone concierge but the numbers are few to take the leap docs just do not know how to set it up and succeed fear rules
local hospital with big medicare numbers has dropped united health care which is the secondary for lots of medicare pts in essence no doctors nor hospital to take care of medicare pts IS HERE
Sermo Doc 61 special problem special special, most don't care, kiss my A$$ with canned speach you got it or you don't no you don't python is the only one I don't have but will many others do and feed I will GLOCK!!!
Remember: AMA has a copyright on the CPT code books. So they do not need physician members to exist. Like AARP is a Medicare supplement insurance company that also has members. We could all rejoin the AMA and vote the current administration out, or all quit. Problem is that AMA has lots of money from the CPT codes. Or, we could get together and make a competing set of diagnostic codes, compete with AMA, and put them out of business. I would conjecture that the deal made with the AMA and the current administration of the federal government may have been the threat that the feds would make their own coding system, and cut out the AMA unless the AMA went along (just a theory, not proven in fact). JCAHO also is employed by the feds to certify hospitals,. and if the hospital is not JCAHO certified, then Medicare cannot contract. This can be examined, too. We as physicians, if we really want quaiity, need to look critically at controlling some if these administrative tools. All the rhetoric is superficial unless we have better control of these as well as the purse strings and proven quality. As an example, there was a brief article in the AMA news many years ago of a national health insurance company owned by all physicians in the country that would take only 5000 dollars per physician investment. This was voted down at the AMA Board of Governors years ago. This may need to be resurrected. We need control again, as we gave it away to third parties that have stepped inbetween the doctor and the patient.
Sermo Doc 14: Don't forget to fire off a letter to the State Insurance Commission and State Attorney general's office for investigation of fraudulent activities of this IPA (even if these are bogus ). You will find out that you definitely will be better off without them and if they approach you again, you will have alot better barganing power the fewer physicians they have under contract. Don't allow yourself to be bitch-slapped by anyone.
It doesn't really matter what mechanism you use for the catostrophic care that everyone needs coverage for, either private or government option - who cares because everyone who works through a hospital (employed or not) will be screwed by this option. But for the clinic based physicians, there should be no reason that the average patient could not pay have the money - UP FRONT!!!! Some will say they don't have the money - Bullcorn - they can buy cigarettes, liquior or big screen TV's, 4 wheelers, but they won't pay a doctor. I say spread a layer of that ointment on them - FUKUMUP and let them get a rash. Shoot, got my thing hanging out of my Y pants.
Dcotors must get over the M&M Syndrome: Being martyrs as good physicians why can't they just continue things "as is"; amd magical thinking, which is to bury head in sand and do nothing and hope someone else does something or maybe nothing will actually happen (I've driven this road 1000 times before and never had an accident, so I never will) Get involved, write your congressman, local paper, patients, friends, countrymen. We will get run over, hit and run and coma in future.
Hayek, the great economist, described our fate in his 1948 book "The Road to Serfdom". Socialism is the end of the road he described, and we have arrived at the final destination. All physicians within the existing "system" are now owned by the government. If they pay you, or their proxy pays you (insurance companies) you are a serf. Take one penny, they own you. Opt-out of everything, or close your doors.
The answer is to reject even one penny of their money. Accept payment only from individual patients. This will never be forbidden. Licensure is secure. People are free to spend their own money as they wish.
I have been doing it this way for 10 years, and making more money in freedom than as a slave in the "system". No codes needed, no billing or billing clerks, no policy wonks or polititians to listen to. Life is good. I recommend it.
The current debate is over for me. Just background noise. I've already voted.
Unfortunately, I think I will be a slave to the system until my loans are paid off or I die. I joke about how "I aspire to be broke someday. " The general public have NO idea how crippling the student loans are for many MDs and none of the new reforms ever talk about student loan relief for current MDs even with talk of reforming the process it talks of loan relief for NEW physicians. So great - now I get paid at a rate similar to a physician extender and yet get to pay off loans the size of my mortgage for the education that they didn't bother with...
It saddens me so much reading this blog that all my colleagues, along with myself, are having to go through this mental anguish day in and out about the future of our careers which were supposed to be completely about helping others and service!! Few of us are wealthy, some of us are struggling to make ends meet, and most of us just want to continue to eek out a decent salary to give back to our families who sacrifice with us (and to pay back our student loans we undertook in order to get the excellent education that would allow us to serve our patients well). You would think with karma and all the compassion that we give day in and day out, that we would get a little back from our elected officials and patients ( after all , they all have to go see their own doctors and know how hard we as a profession work.)
I dropped medicaid a few years ago and medicare last year. Will never go back. Patients will pay for outpatient visits to get the quality care. I take many uninsured patients now , too, and give them good care for a reasonable rate. I am thinking about dropping a payer per year - worst to least worst (note that I can't say "best" when referring to any insurance co. as I feel they are all in the business of stealing ( from the patients premiums by denying coverage and from physicians by denying payments for bogus reasons.)
Gastrodoc- here's my concern. You also are a procedure based specialty- how do your patients feel about paying for a colonoscopy? To correlate to my specialty, how do I present a hysterectomy or delivery charge (around $2500) to an insured patient who could go somewhere else and have that paid by insurance for them. That is why I am still tied to 3rd party payers. Otherwise I would have told them all off a long, long time ago!
PS. If a federal public option plan ever becomes tied to state licensure, then we better all plan to get together quickly to sue for our rights for federal health insurance and other benefits including student loan forgiveness since we will then be "employees " (ie indentured servants), and not business consultants with free will. This we will absolutely have to be united front on- no question.
Please, can someone offer a way that ALL physicians are united? There is all sorts of talk, but no action to unite all with one voice. Payors, hospitals, Medicare are all uncomfortable if we speak with ONE voice as physicians, and act accordingly. The FTC even keeps us from forming large economic organizations by imposing anti-trust laws. All of this complaining will do nothing unless we are ALL TOGETHER. Someone should be able to think out of the box, give real solutions to the problem of unity. From an economic standpoint, physicians can form large economic organizations if there is a collaborative component to improve quality of care. That makes it legal to the FTC. Let us think about this constructively. Maybe start at local levels, to expand to national levels quickly. The system could be brought to a standstill if all physicians said "We can't take it anymore." This may be a pie in the sky, but needs real effort. All of the cries of emotion go to deaf ears as far as the Congress and President. But work stoppage, or try to do medical care without physicians might get their attention.
Let us hope they and the rest of private physicians start dropping out as well!
profound and insightful. You have identified and elucidated the problems, now it is time to take the next step. Every revolution needs a leader. You have the platform. Use it.
I think the pain has just begun...
I'm not so optimistic about AMA. I think AMA will probably lose relevance if the government usurps the CPT coding or brings out some other variation like bundled payment for services( episode of care model).
The employed physicians still need to wake up. Their party will be soon over with their jobs earning slightly less than a PA's take home pay( already the norm here in Columbia, SC for pediatricians).
Community hospitals will be largely staffed by NP and PA types with a figurehead "Physician Leader" and lot of clipboard staff for ensuring compliance.
Physicians working on short term contract for services will be more common.
University docs will be doing less frequent talking circuits and be more at their jobs generating income.
Costs at out patient centers for surgical services will drop steeply as the insurance companies will have powerful leverage under the new rules..By late 2010, before next year's contracts are due, I expect to see more of a take it or leave it attitude from BCBS and similar companies.
Job losses will be massive by mid 2010, no matter what the government statisticians are telling you now. There will be a significant drop in stock market by Sept 2010.
Let us see how this goes....
Section 1 of this act shall be repealed upon such date determined by the Commissioner that a common payment methodology has been implemented across all public and private payers across the commonwealth.
Is Single Payer anticipated to the point that it's being written into law as a contingency?
excellent post Dan, can you get this in the WSJ or NY Times and other major newspapers. Send it to Glenn Beck, he'll read it onair or post it on his wweb
That first portion is excellent advice for everyone, but, the last line..."Try to tune out everything but the patients and their needs. Everything will be OK in the end." is very dangerous advice. We all owe it to ourselves and to our profession to stand up for what is right and defeat this corrupt nonsense. Tuning out is not the answer.
I decided to let go of my hired-but-yet-not-started employee as I am not too hopeful of the changes coming and doubt I can afford not to keep tight leash on overheads. Passage of senate bill changed the equation for me. Now, I am actively seeking ways and making plans to shut down my practice.
(PWI= practicing while intoxicated)
SERMO is the single most important repository of common sense, if only the politicians care to seek unvarnished advice.
NO doctor will shed a tear at the demie of AMA, except perhaps the AMA employed, generally not practice worthy docs.
One example will suffice to highlight the difference. I used to work in employed setting with a large regional Kaiser like HMO run practice. In my 3 years with them, there were 3 instances when pt could reach me after hours. In my current private practice, pt have my personal cell phone number.
Probably, pt will get used to it. As such pt have very little control over quality and value of their money in current system. It will be drastically down to almost zero when reform and other changes are finalized. They will pay what Govt/Ins co demand in form of taxes and insurance premium and they will get what Govt/Ins co/corporations decide.
I guess, they will get what they deserve. Pt are so full of entitlementisis and have not taken any active role in influencing any control of value of their money.
Other highly likely trend is significant drop in quality of medical school entrants. We can track their pre-med school exams performance scores and objectively assess the change.
Came across a radio ad a few weeks ago with a statement:"circumvent government healthcare" Just looked at their site last night;they seem to represent everything most here are for and against.Cost to join is $19.00.If a large number of SERMO members join,it would for a formidable voting block in 2010.Just not sure what the pros and cons of joining are yet.
They plan to broker medicare advantage policies!
To me, it looks like another group of work-from-your-garage enterprise trying to sell insurance and bring customers to businesses. ...... perhaps a grp focusing on baby boomers trying to unite them to get more free goodies.
YOU GO DAN!!!!!
Thanks Dr President:, wholeheartedly agree with your predictions!
What SERMO has initiated is a voice that reverberates to patients and nonmember physicians are either aroused with enthusiasm or curiosity to join the bandwagon!
The SERMO initiative needs to be continued with greater momentum and change for a higher level of professionalism, respect, camaraderie and collegiality among members !
Disagreement should always be constructive that exalts the integrity of the medical profession as observed from the "outside online lookers" .... and not hitting below the belt!
Its been encouraging to appreciate sincerest, honest thoughts of colleagues and majority I believe had been commendable and been very proud of!
Agree with the above, in most SERMO doctors attitude of tolerance and flexibility in facing the current health care change (onslaught) with the view that majority of us will not be coerced thru political expediency and AMA "submission!'.
On the other hand, positive innovations, respect and dignity of the profession is upheld thru AMA "purging' and DC political bullying!
Under your leadership, 2010 will be very exciting and the face of health care will definitely purge the medical structure because of AMA failure to uphold the dignity and integrity of the profession.
The positive change will redound to increase both in quality and quantity of SERMO doctors being in the affront of health care both in pt-physician relationship and national representation!
Thanks for the utmost opportunity to share and see your invaluable but very productive leadership!
If you can stand the heat, pack your guns and try Texas...land of the free and home of the brave!
There's no future for Docs in Massa-useless!
Isledoc-- Did they fix the problems with the taliban medical board there yet? When they do, I might have to move back home.
It seems from the press that everyone agrees, both Rep's & Dem's, that defensive medicine needs to be addressed, yet no one will actually do it. Are doctors doomed to be litigated out of existence, or will someone rescue Americans from legalized greed?
Just thinking random career thoughts here!! :-)
The same doctor working for the hospital cannot bill for the wound care or the bandage supplies but if he sees the same patient in the hospital clinic the hospital collects $300 facility fee and additional supply fees. Moral of the story; If self employed docs cannot take care of medicare patients in their office the government will pay 6 fold for the same care delivered by same doctor now closing his office and now working for the hospital. Penny wise--pound foolish.
Post-operative global care applies only to the operating surgeon or whoever performed the procedure. If someone else sees them, they can charge for the visit.
We are not using EMRS due to the expense. a tiny practice just cannot afford it.
would love to drop medicare.
The entire drift is to make physicians government employees. Has been for years.
Answer: Unionize and go out on strike
1. I'm in the process of exiting Medicaid, and have noticed that many aspiring new patients, when told I no longer take Medicaid, choose to pay may fee and see me anyway. Fact is: most Medicaid patients can afford cell phones, gasoline, cigarettes, cable TV AND $100 to see the doctor every month or two.
2. Many Medicare patients care more about the quality of their doctor than about who pays for the visit, and can afford to pay $100 to see the doctor every month or two.
3. Most patients who need to pay a Sermo Doc 33 a $2500 fee to have their appendix or gallbladder removed or a hernia repaired can put it on their credit card or get a relative to help them pay for it.
4. Most of us can make an excellent living collecting $100 per visit, as long as we're not squandering half our time and $100,000 per year futzing with CPT/ICD codes and jumping through Medicare/insurance hoops.
5. It is both unethical and inefficient for patients or physicians to allow third parties to insinuate themselves into the patient-physician relationship.
6. An efficient healthcare economy CAN ONLY RESULT from patients and physicians negotiating services and fees DIRECTLY WITH EACH OTHER, as occurs in all other segments of the economy.
7. The only valid purpose of insurance it to protect against catastrophes. Once doctors begin to behave in an economically enlightened manner, maybe patients and Congress will too.
Dan Jones, MD
www.JonesPlan.BlogSpot.com
WE MUST STOP the INDEPENDENT PAYMENT ADVISORY BOARD (formerly IMAC) NOW!!!!
Please Email Your Representatives in Congress and Ask Them to Sign The Neal Letter Stating They Will Not Support Any Healthcare Reform Bill that Contains This Provision!!!
The AUA needs your help! Please ask your Representative to sign a letter being circulated by Rep. Richard Neal (D-MA), which expresses strong opposition to the creation of an Independent Medicare Advisory Board (IMAB)---the unelected, unaccountable Medicare payment policy board which would potentially have unilateral power to change Medicare payment and policy without Congressional oversight. This proposed board would replace the current Medicare Payment Advisory Commission (MedPAC), which serves solely as an advisory group to Congress.
In late December, 69 members of the House of Representatives joined together to send a letter to Speaker Nancy Pelosi (D-CA) clearly stating their strong opposition to any proposal that would divest Congress of its authority for Medicare payment policy and place this responsibility in an executive branch commission or board. Because of such a strong response, Rep. Neal is providing an opportunity for House members to add their names to this important letter.
While the House-passed health reform bill, the "Affordable Health Care for America Act" (H.R. 3962), did not include provisions to create such a Medicare board, the Senate-passed bill, the "Patient Protection and Affordable Care Act of 2009" (H.R. 3590), does include provisions that would create such a Medicare payment policy board, which would be called the "Independent Payment Advisory Board" (IPAB). The creation of IPAB would effectively end Congress' authority over Medicare payment policy and would also empower this board to make policy recommendations regarding health care provided in private, non-government health care settings as well. Placing such important decisions in the hands of a commission without appropriate checks and balances in Washington could have a far-reaching adverse impact, not only for Medicare beneficiaries, but for all Americans' ability to access quality surgical care in their communities.
We need your help in letting Congress know that urology opposes these proposals to create such a payment policy board.
Please Email your Representative TODAY!!!
I was not particularly optimistic. I was just showing way to reduce pain.
With each day, things are changing for the worse. I got a notice from local IPA that they will not be paying for level 4 service anymore. Medicare consult code elimination is a non-event in my town. Even with my low overhead model, there are issues that are not addressed to optimal level like sexual harassment issue. There are other issues that I just do not have good answer for like what if down the road ins co decides that coding was wrong. What do I do? Go to court? for 10 dollar? They know weakness of small practices. Pt dont care. They would rather spend money on nail spa than on their health.
I say:
FUKITOL
Daniel Jones
www.JonesPlan.BlogSpot.com
Some comments I *entirely* agree with and that I feel need to be emphasized:
It is both unethical and inefficient for patients or physicians to allow third parties to insinuate themselves into the patient-physician relationship.
An efficient healthcare economy CAN ONLY RESULT from patients and physicians negotiating services and fees DIRECTLY WITH EACH OTHER, as occurs in all other segments of the economy.
The only valid purpose of insurance it to protect against catastrophes. Once doctors begin to behave in an economically enlightened manner, maybe patients and Congress will too.
Is FUKITOL over-the-counter or by Rx...sounds like something we could all use once in a while! Maybe it'll warm you up there in Florida! :-)
All Physicians in Mass all of the sudden qualify for the same benefits. They need to class action sue the Mass government as they are unfairly excluded from rights of government employees by incorrectly stating that they are consultants. By definition, consultants have a choice of whether they work for the government, whereas state employees do not. So, not granting those physicians state benefits, is a federal labor law violation. I am not a lawyer, but I may become one... Anyways, those docs are some lucky folks.
Your three major issues galvanizing physicians and your four predictions are refreshingly candid and accurate compared to the AARP and eAMA Newsletters and their cynical, and probably likely to fail, back-room dealings with Congress.
If, as was revealed in Massachusetts Senate bill #2170, the state Health Insurance Commissioner actually now has the power to implement a "common payment methodology across all public and private payers across the Commonwealth" , the only practical response of self-employed, office-based MA physicians is to organize and create multiple multi-specialty single tax ID group practices throughout the state.
Maybe the more than 500 IPAs and over 200,000 doctor members of the 16-year-old IPA Association of America (http://www.tipaaa.com) could become the catalyst for such a proactive business model transformation.
Bob
Does seem like more chaos is coming, however, and what the outcome of all that will be is not at all clear.
I have been upset all day after I got this letter from the local IPA telling that they will not pay for 99244, 99204 and 99214 and will pay only for corresponding level 3 when these are billed. It is unilateral, arbitrary and has nothing to do with patient care but is just an extortion and stealing of services.
After hours of thought, I have decided to send my termination notice first thing in the morning.
Its not worth it.
I did not sacrifice 15 yrs of my prime of life to have the privilege of taking this bullshit. Their actions do not help me take better care of my pt. I can not tell my pt that I am not allowed to provide more than a certain amount of service.
I am done with this IPA.
I will make less but I will sleep better and have my dignity and conscience intact.
I am relieved.
Any tips what not to do what to do in term letter? This is my first. Today, I complete 6 months of my practice opening.
Everyone:
say it loud with me: FUKITOL
But don't get excited folks, we already had a majority in the house and senate, a republican president, a doctor (Bill Frist) as senate majority leader and nothing good happened for us or healthcare, including Tort Reform. Some republicans even voted against tort reform and some didn't show to vote.
So not trying to be pessimistic, but I just don't any doctor wasting his or her energy or get distracted with this presumed takeover of Congress and false hopes, but rather channel the time and energy as Dr. Palestrant illustrates in this article, including dropping Medicare if necessary, etc... and fight the wright war.
*correction: the right war
Spending the necessary time with patients is not wrong; it is not wasteful; there are times when it is needed, and we all deserve commensurate compensation.
Toasting you with a glass of Autonomy as I swallow my Fukitol IR
I predict that most doctors will be the same business idiots we always are and simply do the same exact thing that we always do and for some retarded reason expect that doing the same thing over and over again will somehow, someway, by some miracle of divine intervention result in a different and better result.
Thanks
BTW, what I am sending them is a suppository form of Fukitol.
After I am gone, their network will have only 1 Endocrine and he is not much liked around here.
Ins co cease to exist if they dont have enough doctors in their network.
I can find other ways to survive.
Things will get worse before better. Primary care will lead the way, specialists will have to figure out their own routes. But primary care will be the element that corrects the patient/physician relationship. Thanks to you all and blessings.
When you terminate with the IPA, send them an Rx for FUKITOL and ask for payment in full or else they'll hear from your attorney!
You're a good Doctor...we need more like you to speak out and change the system!
"... whenever the Legislators endeavour to take away, and destroy the Property of the People, or to reduce them to Slavery under Arbitrary Power, they put themselves into a state of War with the People, who are thereupon absolved from any farther Obedience, and are left to the common refuge which God hath provided for all men against force and violence. ... [Power then] devolves to the People, who have a Right to resume their original Liberty, and, by the Establishment of a new Legislative (such as they shall think fit) provide for their own Safety and Security, which is the end for which they are in Society."
John Locke
If I could charge pt (even 20% of them), I would never sign any contract. My practice is new and my area is high poverty rate area.
Dropping out this insurance may turn off many referral sources. But, I can not afford to have my BP go up like it did yesterday. I will live with few thousand less.
However, Dan, I believe that you have missed the progressive's " final solution," and that is to outlaw private practices......or tax them out of existence.
For now anyhow, my plan is to continue seeing patients in medicare if congress ultimately fixes the formula. ( one can hope, at least)
If they don't, this FP will have to quit all plans and "go concierge".
Instead of my current patient population of patients and going broke, I've already calculated, I can charge $1000 per year, and easily provide the same level of care I do now, as long as 500 patients take me up on it. The reduced expense of such a small patient group, (even though they may be more demanding folks), includes reducing office size, staff down to ONE assistant, and a life devoid of 70 hour work weeks. In fact, my estimate is this will double my take home pay!!!
So, I could do this untill the gov't outlaws it too.
Though I'd be bored with the short easy days, and feal bad for the patients I'd have to leave behind.
I JUST DON'T KNOW IF I HAVE THE KISHKAS (guts) TO DO IT.
My first year in this model was better than any other year in many ways:
I am seeing fewer patients per day.
I allow myself more time with each patient.
I allow myself a full one hour break during the day (I was never able to do that when I accepted insurance).
Patient care has improved--I am coordinating care with other doctors much more effectively.
My case load has gotten smaller, and so I get fewer after hours calls.
Patient attitude is different--they take their health much more seriously when they are the ones paying for the appointment.
I can get patients in for a follow up appt the same day, or at least within 1-2 days.
I have a much better attitude at work because I KNOW that I am getting paid for each and every appointment.
If I decide to take on a charity case, it is MY choice.
I feel like I am practicing medicine the way it is meant to be practiced.
I no longer have to pay a billing service to submit claims for me.
My gross practice income and my salary INCREASED this year.
I am happier and my family life is much improved.
It was a scary step to take, but opting out of Medicare and converting to a cash practice is a very realistic option. I believe it is not just unique to my specialty, either. I think just about any doc with an outpatient practice could make this option work...provided that your neighborhood isn't flooded with docs in your specialty. If you provide quality care, your patients will be willing to pay for it.
Well said.
For years, ever since I stepped into USA as an FMG in 1994, I have seen this writing on the wall. Better late than never, I developed a plan for myself, when others laughed at me. I slogged through my MBA and developed a plan B for myself and my family.
For each and every one of you physicians out there, get your heads out of the sand - The reality is that there will be significant upheaval in our practice models, legal atmosphere and economy. By the time the dust settles, it would be a significant time you lost in your life - may be next 5 -10 years.
You will never regain the fee for service model from 1950s unless you stand up and do something about it. The first thing you should do is to liberate yourself from dependency on your physician career. Then you will have the clout to say and get what you want.
Please get into an alternative career along with being a physician - get into real estate, get into software development, get into healthcare administration (where you can make millions in salary for 9-5 jobs for 5 days a week and no pager).
But never give up....
By the way, Texas enacted tort reform only when the bow was about to break. 5 -6 yrs ago every one was running away from TX because of bad malpractice hellholes there. Expect the same nationwide. The only time when the whole nation will streamline its interests and want to follow the right path and truth is when cataclysms occur. Otherwise, democracy will continue to pit 49% against 51%.
As long as we can not function independent of it, we will always be subject to unilateral, random rules and unfunded mandates which may not have anything to do with improving quality of care and may cost us more money. Such things will keep adding to our frustration and will take increasing amount of our time away from patient care.
I was hoping that we may devolve into direct service - direct pay system but now that chatter of tying license to accepting GovCare and expansion of entitlement program in healthcare is getting louder, I am scratching my head to find a complete exit plan.
No matter how much I like getting diabetes under control, I can not do it at complete annihilation of my personal life.
I think it may be a little easier in Psychiatry. A friend stopped practicing for a year when his wife died. He reopened his Pyschiatric practice and sublet space from another psychiastrist. My friend does cash only, $50 for a half hour. He did it just to keep busy and thought he would probably make a little money. Just working two days a week.
he is now very busy, very happy, doing very well with cash only on a low fee!!!
Unfortunately, we are in debt and old docs and just can'[t get out of it right now. Wish we had another income stream.
The specter of Obamacare has at least woken us up. 2010 will be a crucial turning point. WHAT TO DO? Right now, you can donate to Scott Brown's campaign. He is the republican candidate in Mass. seeking Ted Kennedy's vacated seat in the special election to be held on Jan. 19. (Hence the push to "pass something" before OB's State of the Union address which might be on Jan. 20).
See the letter below from Docs4PatientCare and Scott Brown's websit for details. If everyone above sent in even $50 it would be a big help. I live in Michigan and just sent in a donation. This particular race is not just about Massachusetts!!! Bill Clinton himself is scheduled to appear to support the Dem candidate. But wouldn't it be great if the demise of this very bad "healthcare" bill came about as a result of the replacement for TK's seat?!!!
Dear Doc 4 Patient Care Member
There is a special election on January 19 in Massachusetts for the vacated Senate seat. Scott Brown is the Republican candidate running for that seat. He is on record as stating that he will vote against the Healthcare Bill. He would be the 41st vote and would enable the Republicans to filibuster this bill. This is a Hail Mary pass. It would be a miracle if he won Ted Kennedy's seat. However he was 19 points behind several weeks ago, and is closing. He now is in a statistical dead heat according to one poll today. The polling data assumes that people will show up at the poles to vote. A snowstorm or inclement weather will keep people away. Anything can happen.
The people in the leadership of Docs 4 Patient Care have all personally supported the Brown campaign. We have donated money which he needs to keep the pressure on. I would urge every person receiving this email to go to Scott Brown's web site (http://www.brownforussenate.com/) and give a generous contribution.
This may be our best shot; our only shot to stop this horrendous bill, which we all know will change medicine for the worse for us, our families and for our patients.
Good luck to Scott Brown and to all of us.
Hal
Hal Scherz MD
President & Founder, Docs 4 Patient Care
www.cms.hhs.gov
It is not immoral to make a profit for providing a quality product. Criminy, you will die from lack of food much more quickly than you die from lack of health care coverage, but nobody is calling grocers immoral, avaricious, greedy, etc., or trying to socialize the grocery industry. Unsafe cars can kill people as quickly as unsafe medicine, but are we socializing the auto industry? Oops, my bad...
Support him.
are planning to exit earlier
especially if medicare dependent
better to retire than to go broke working
some have gone concierge
but the numbers are few to take the leap
docs just do not know how to set it up and succeed
fear rules
local hospital with big medicare numbers
has dropped united health care
which is the secondary for lots of medicare pts
in essence
no doctors nor hospital to take care of medicare pts
IS HERE
special special, most don't care,
kiss my A$$ with canned speach
you got it or you don't
no you don't
python is the only one
I don't have but will
many others do
and feed I will
GLOCK!!!
The answer is to reject even one penny of their money. Accept payment only from individual patients. This will never be forbidden. Licensure is secure. People are free to spend their own money as they wish.
I have been doing it this way for 10 years, and making more money in freedom than as a slave in the "system". No codes needed, no billing or billing clerks, no policy wonks or polititians to listen to. Life is good. I recommend it.
The current debate is over for me. Just background noise. I've already voted.
I dropped medicaid a few years ago and medicare last year. Will never go back. Patients will pay for outpatient visits to get the quality care. I take many uninsured patients now , too, and give them good care for a reasonable rate. I am thinking about dropping a payer per year - worst to least worst (note that I can't say "best" when referring to any insurance co. as I feel they are all in the business of stealing ( from the patients premiums by denying coverage and from physicians by denying payments for bogus reasons.)
Gastrodoc- here's my concern. You also are a procedure based specialty- how do your patients feel about paying for a colonoscopy? To correlate to my specialty, how do I present a hysterectomy or delivery charge (around $2500) to an insured patient who could go somewhere else and have that paid by insurance for them. That is why I am still tied to 3rd party payers. Otherwise I would have told them all off a long, long time ago!