I think the problem lies in that they refused to consider the proposal sent over by the unsurance company at or below medicare rates.
The insurance companies can collude to thier hearts content, but let physicians refuse to provide a service below it's cost of production, but one that the Fed insists you take, and you are breaking the law.
I guess the correct response is for the IPA to present the contracts to their members, but then no one signs them. Same result, and a stronger negotiating message.
A decade ago, when every community had groups trying to organize IPAs and PHAs, my community hospital went through the gyrations to do the same, albeit not very successfully.
The consulting group that tried to shepherd us through the process had their lawyers present the legal case to us in detail. It's been too long to recall exact details, but there was a series of conditions that had to be met to qualify the IPA as an entity legally capable of negotiating for the group.
The FTC's complaint here is all about how these were actually COMPETING physicians acting in collusion. It would be interesting to understand if the FTC's consent decree against this IPA is because they have found an angle to disqualify ALL IPAs, or if this group just forgot to dot a few i's and cross a few t's.
That is great news! Now we can't even negotiate rates. Let's see... X percent of free is how much? Hmm... And you can't sue the government.... Well, you get what you pay for.
As I tell my residents, just like war, you need an exit strategy for medicine. I plan on either opening up an egg roll shop, doing a surgery residency then medical missions or using my engineering background to patent some things.
This is nothing new. Google "South Geogia Health Partners".
IPA's have no real leverage if the FTC comes calling, since the members are usually economic competitors. Now, if all the IPA members were to create a fully integrated multispecialty group with genuine shared financial risk, they could accomplish what they set out to do.
I guess it's time to quit medicine and find another profession. Then we docs can secretly provide medical care to each other like the underground railroad. All the masses will languish without enough docs. Is this what I trained for for over 30 years?
I didn't have an 8:30 patient this am so, I actually read the industrial strength original FTC opinion. (Amazingly it's only 8 pages)
I'm no J.D.
But it looks like the IPA tripped up in several areas.
To be anything other than a messenger IPA you have to share financial risk or have significant clinical integration that demonstrates some kind of benefit to patients. Also, the IPA banned rates which were stated as a percentage of medicare rates and recommended a COLA (cost of living allowance) to be built into it's contracts. OF course the reasoning behing the ban on medicare based rates was very likel due to the SGR mess. The FTC appers to dislike this combo as it seemed to be a built in pay raise year to year.
I've seen this financial or clinical integration argument come up time and time again, so I think that provision is one to take VERY seriously with any other than a messenger IPA.
This looks like the FTC will not allow an organization like an IPA to work. They did the same thing a few years ago to a physicians union that was being established in the northeast. The main players for the union where dragged through a similar legal challange that killed the union.
There is a concerted effort to eliminate any form of third party messanger system to help the small physician entities gain any clout
any recomendations for a 4th year psychiatry resident who wants to open his own practice someday? Is there a viable option to never accept medicare or is that pie in the sky thinking?
What we need is the AFL-CIO MD division. They can't put all of us in jail for striking. (OMG he used that dirty word). It seems that the only group in the US that is subject to the anti-trust laws is physicians.
We all should have organized 20 years ago, We have been divided and conquered, and just sat on our hands while it was happening.
I think a lack of public awareness is the biggest problem here. We can't let the AMA keep talking for us.
This is one of the first signs of enslavement of Medical Professionals, Doctors specifically, both by the public and private sectors.
Some of us tried to get up and fight (Roaring Fork Valley Physicians IPA) and they were subdued.
What do we do next? This has got to become an all out battle! We're being backed into a corner by Government (both Republicans and Democrats) and by Insurance companies, with ZERO concessions being made to us.
We need a stepwise approach and a multi-pronged attack. We need to make a case to unionize. We need to make television campaigns, Youtube campaigns, billboards, commercials. We need to stir the pot, create some noise and get attention to point out, at least to the younger generations of what "they" do to people who work hard, pay up for education, to follow their dream of becoming Physicians.
Lastly, Sermo is not a catchy name. We need more visibility.
My sympathies go out to the physicians in the network, who, I have to think, were misled by the people who formed this IPA that somehow this would not constitute a breach of antitrust laws. Clearly they were mistaken.
It goes to the heart of a fundamental contradiction that is inherent in our health care system in that physicians are expected to act like businesses - meaning that their expenses, taxes and tax structure, wages, proftis etc are their concern, and yet they are at a competitive disadvantage against BOTH big business and government in obtaining third party reimbursement. And no, you cannot negotiate collectively. As they say on the speed limit signs, It's the law.
My feeling is that healthcare will eventually become salaried and cash only/boutique. Absent general political will to level the playing field between private practitioners and big business, I just do not see private practice as a long term sustainable model, at least in this country
We are not tradesmen. We are professionals. How can we be subject to any ruling by the Federal TRADE Commission? Why have we accepted this?
This is not news. The very same thing happened to Memorial Hermann HealthNet Providers in Houston about 4 years ago, after which the rates we were offered by all the Managed Care Plans went down. My practice income went down 11% and of course my personal income plummeted 22%. Now MHHNP has developed an integrated practice model according to FTC guidelines, but so far they have been unable to negotiate a single contract with managed care.
and by the way, I have yet to hear of any sucessful unionization effort between small businesses. Unionization occurs AFTER you go to work for big corporations and get paid a salary. Otherwise, you are management, with the government specifically refusing to recgnize as valid any 'union'.
What have I been saying - the government is completely out of control and WILL control you. Very soon medical licensing will be dependent on accepting medicare and you will be a serf to the government's whim.
This should be a clear sign that the war against physicians is very real. It's time to bring it.
The AMA is your totally inadequate Union, which is one of the largest lobbyists for the specialists, who are generally overpaid because they use their hands versus the generalists who spend more time with patient and are underpaid because they use their mind.
We already have a quasi-socialistic system where insurance companies, under the guise of HMO, PPO etc. set the price for service, regardless of each individuals need. there is no free market competition. What is the difference between HMO's and Medicare/Medicade? Nothing, they both screw the practitiioner as well as the patient. The only difference is who benefits.
My advice to all new physicians. DO NOT EVER SIGN THE FIRST MEDICARE CONTRACT.
Once you do, you are INDENTURED FOR LIFE and you have GIVEN UP YOUR CIVIL RIGHTS - specifically your right to trial by a jury of your peers and your right to terminate a contract.
Do not let your residency program "obtain a medicare number for you." Do NOT SIGN ANYTHING with Medicare. Ever.
This is our government-----The United States Of America !!! If you're not for it ----then you must be one of "those unpatriotic unamericans "---I love this ever so conservative site !!!
Again, I am thinking of amazing business wisdom of Sermo Doc 78. Creating a mega corp of employed/partner practicing docs is the only way to survive in future.
We can work for a corp run by suits or one run by white coats.
Choice is yours.
No one is going to do well in solo/small practice. Its just too much of headache to work for pittance that current rates are and it is getting worse by the day.
The groups that have formed large LLCs in the Bronx and Westchester, NY, specifically ENT, urology and recently GI have been successful. They either negotiate a better contract or go out of network, but you have to have a critical mass of physicians in a given area, which again means you have to ORGANIZE.
Chet, if we are really small businesses, how come are fees are fixed by our "clients".
The actual price fixing, of course, is done by our government. I always ask my colleagues, "Why is it that lawyers can charge senior citizens whatever they choose to, but I am forced to charge seniors who literally are multi-millionaires the Medicare rate since they are Medicare eligible?" The answer is that it was lawyers (liars) who drafted these restrictions for others, just not themselves.
"We need a stepwise approach and a multi-pronged attack. We need to make a case to unionize. We need to make television campaigns, Youtube campaigns, billboards, commercials. We need to stir the pot, create some noise and get attention to point out, at least to the younger generations of what "they" do to people who work hard, pay up for education, to follow their dream of becoming Physicians."
Well, of course. Why then is it so hard to get anybody off the ass and join a new group? Docs4PatientCare is a new group - no bad baggage - only wants to help our cause - and there are people here who nit-pick the effort to death because of a NAME for the love of all that's holy! It. Is. A. Start. So join.
haven't been on sermo in a while - periodic burn-out....but this has my attention...absolutely agree that you don't get paid to think, just do....and absolutely, small practices are doomed unless you are the only game in town....
Moving to Australia or New Zealand is looking more attractive all the time. My ER doc friend who did it is deliriously happy. She says the pay is reasonable and you don't have to beg for it, no malpractice and patients actually say thank you!
Again, Mayo in AZ started it, we all need to finish it. As a nation we should drop medicare acceptance and accept them as fee for service patients. The elderly will scream loudly and quickly to the governement and we will reach a solution....
#8. My own answer being the integral summation of=
#2. "Yes", I too am emotionally (but not cognitively) apopleptic;
+
#6. "Socialized medicine - its already here", at least in intent. That's why I've suggested the prospective options of either Mussolinian corporativism or Neo-Stalinism.
+
#7. "...Look to what other physicians have done in other developed countries when forced to accept unacceptable terms." The predicatory elipses denote the negation of proffered options of either litigation or unionization. Regarding the former option of litigation, the Feds have, for all practical purposes, unlimited legal resources & powers (especially given 20th century judiciary-created Federalization of 14th & 15th Amendments plus Lib-Left Earl Warren Federal expansionism). Hence, I personally doubt that the well-intentioned suggestions by peer Sermoans in this column to redesign corporate law for the benefit of clinicians will prove practicable without 'coupling' to legistlative power & action (a la the maligned AMA). Regarding the latter of option unionization, other Sermoans have pointed out various mid-20th century so-called anti-trust statutes that prohibit unionization by & for MDs. Seeing what MDs in other countries do is much more likely to be useful-not for purposes of either simplistic transposition (to USA) or simian mimicry (by USA MDs). Rather, US medicine should be like the late Meiji Restoration Japan--learn well from the virtues & vices of the technics of other developed countries & then adapt!
Wow. I'm impressed that this is actually happening. We as a group need to respond. I know as a whole, SERMO is AMA friendly, but what are they doing about it.
Unionize and do what? Have some you folks heard of a lttle thing called patient abandonment. That is frowned on upon by the establishment and will get your privledges yanked faster than Obama can spend money and makes the John Edwards of the world a little bit richer in lawsuits. I think we need to understand that we have lost this fight and are slated for replacement. Medical schools are expanding, DO programs are proliferatiing, and the sheer number of new doctors with staggering debt is growing exponentially and THEY will ultimately be the slaves of the government who can do nothing but toe the line and will replace all us who went in medicine for the patient. I have friends in some high places and this is all the talk in Washington. It was actually said that they want us to leave medicine. So I agree that EXIT STRATEGY should be our next plan.
"What have I been saying - the government is completely out of control and WILL control you. Very soon medical licensing will be dependent on accepting medicare and you will be a serf to the government's whim. "
And as long as residencies are supported by CMS, this is bound to happen. In fact, I foresee in the not-too-distant future that acceptance into ANY residency will require signing an agreement that the physician will provide care for Medicare/Medicaid patients, if not as a condition of licensure, at least for a set period of time during and after residency.
If we want to do battle with Goliath, we need to make sure that he can't lay ANY claim to our slingshots and stones!
... Can't control... RAGE! Must calm down. Need a f@#%ing hit of FUKITAL. Seriously, Lets all go on vacation for a week in July. (Got help those on-call, you know that sweet deal that we can't seem to get out of).
Good for the FTC. This sounds like a sham IPA whose only concern was to jack up fees by cornering the market. If you want to be in a big group that is fine but if you are competitors then you can't price fix unless of course you happen to be some of our giant corporations and even they get nailed occasionally.
There is nothing new or precedent-setting in this ruling; it is just like dozens of others over the years.
The problem is that this IPA, a collection of competing physicians and physician groups, failed to comply with the rules for a messenger-model IPA; they agreed as a group to set a minimum floor for commercial contracts. The fact that the minimum that they set was Medicare rates is simply coincidental; they could have just as easily (and just as illegally) picked a specific dollar amount. The problem is that these were competing physicians, and they therefore cannot collectively agree on minimum rates that they will accept; in order to comply with the messenger model IPA regulations, they must each independently set their own rates and the IPA must not facilitate sharing of fee information among members of the IPA. If they want to negotiate jointly, then they must become a group practice, not an IPA.
There is nothing in the ruling that prevents any individual physician, or any physician group practice, from refusing to accept Medicare rates from any commercial insurer; it simply enforces the laws that prevent competitors from working together to set prices.
I'm in an IPA not far from our Roaring Fork brethren. We hired a lawyer, and changed our day to day IPA operations after a similar FTC inquiry into Grand Junction's IPA occurred a few years ago. Basically, you can only negotiate as a group if your are in an "at risk" contract with the insurance company. All other contracts are between the individual practice, and the insurance company. If you try and block this with an IPA or any other entity they will immediately cry foul and call their lackeys in the FTC. It is in the interest of the insurance company to negotiate individually with us obviously, since we don't know what anyone else gets paid, and are at their mercy.
Sermo Doc 41, Fukitol is now a subsidiary of FUBAR ! They are asking for stimulus money to attain their objective !! Please go to healthtrain.blogspot.com for further commentary on our present admin and congress.
How does anybody expect anybody to willingly apply to medical school in upcoming years with all with BS going on. One of my sons told me the other day: "When I grow up, I want to be a doctor. . . . . or work in a grocery store." I think the grocery store is the better option.
1) Individual physicians (or small groups) must be willing to refuse bad contracts (or fees). The "correct" price for any service is the lowest price that a provider is willing to accept. Whining and begging don't count. If I were a CMS beaurocrat I would say; "They complain about the fees. But they keep working for them. The price must not be quite low enough yet." 2) In every part of our economy, purchasing coops are legal, but when producer/providers cooperate, it is price fixing. It is a fact of life.
nginn: "will get your privledges yanked faster than Obama can spend money"
While not disagreeing with the thrust of your argument, nginn, there's no need to exaggerate. It is no more possible to yank a privilege faster than Obama can spend money than it is to yank a privilege faster than light can travel...
Refusal of bad contracts or bad fee schedules must be done on an individual or small group basis. BUT our medical societies could do more to help, show, and encourage its members to do this.
Group voice - not AMA - join together - only salvation - even that ain't perfect, but do you prefer to bitch from the sidelines? D4PC -- or, if you prefer, any other similar, doctor friendly organization.
"As I tell my residents, just like war, you need an exit strategy for medicine. I plan on either opening up an egg roll shop, doing a surgery residency then medical missions or using my engineering background to patent some things. "
Sermo Doc 14, you sound like your lithium dose needs adjustment :)
Sermo Doc 15 is right - this is old news. The FTC shut down a similar IPA in Denver in the 90's for the same reasons. The fact that everyone is shocked is depressing -. This is old stuff.
I stopped smoking all in one day-had an intellectual epiphany; threw 'em in the wastebasket, and never smoked again. The epiphany was the realization that lung tissue is the only tissue in the body that does not regenerate, and I wasn't paying somebody to ruin my life. Made it easy to stick with my resolve. Gave up Medicare about 6 years ago-all in one day-boy do I breathe easier.
If you think we are living in a democracy, then you must have been a hermit for the past 2 decades. Our government has become so powerful and corrupt that it can do nearly anything , constitutional or otherwise, to any citizen. Whereas even countries with socialized medicine usually permit private medicine to co-exist, our government has made it nearly impossible to do so. The best thing is for doctors to unite and strike but then it will be against the antitrust laws . How many of us have the guts to risk financial ruination and jail time? At least to me, the best answer may be retirement from medicine which is already on life support.
The IPA got into trouble because it acted as a group. It is not illegal to refuse Medicare or Medicare rates as a individual or to refuse any other unfavorable contract as an individual. Obviously this imposes a severe logistical and legal nightmare on hospital based or employed physicians and large groups to avoid antitrust issues.
Hey Sermo Doc 52------You don't like our government---I'll say to you what "your types" yelled at us when we were protesting the Vietnam War----- " If you don't love it---then leave it "
How many of you are 65 or over and have paid inordinate health insurance rates over the years and looked forward to not being totally ripped off by paying exorbitant insurance rates by finally qualifying for Medicare rates? I have worked my posterior off for many years. So now with all of you exiting Medicare who will do my medical care when its time - knock on wood, I take care of myself, but the inevitable will appear at some point. Cripes unionizing doctor ideas is as old as the hills and goes back to my med-school days. Game over is correct. So I ask someone to tell me what they want their health insurance rates to be when they retire ? Medicare unfortunately reaches out to the lazy as well as the workaholics. The system is horrible. I escaped it from the doctor side years ago, but changing what I was doing so I didn't have to deal with it. Dealing with it as an eligible citizen is strange, a bit of a nightmare and frustrating. The system is crumbling - that's the problem. I hear the complaints, the problems, etc. but we need to be proposing a real-time solution. What an impossibility has been produced and someone is making the $$ off the system....they always do, but it isn't the docs. I wonder what it will look like when my kids reach 65 or how about what it should look like when each of you reach 65 or will you all be able to fork out $1000 per month for some kind of health insurance ? ! Interesting.
It is time for physcians to unite and standup to this non-sense. Unfortunately, we were all brainwashed in med school thinking the AMA was on our side. They are not! It is time to standup against the AMA who is contracted by the government to set our fees! We as physicians desperately need a true lobby in washington.
Sorry, I didn't read all the posts, but most of them, so forgive me if I am repeating something. I think we may have a bonafide test case here, so I don't think we need to be so negative. We should countersue the sh-t out of them! I believe that THEY are the ones acting in concert to fix prices. Further more, if they are treating the Respondent as a corporate entitiy , according to the latest Supreme Court ruliung a cCorporation can act as if is a single person in in certain circumstances.. I cheer this IPA. I think they should hire the best attorneys in the country, and we should start raising money for their defence.
Just read the rest of the posts. All of you get off your high ideological horses. This is something real that we can do something about.. We don't need an organization, just the ad hoc commitee to defend the Roaring Fork Valley Physicians.
Guys, it has been mentioned above but I'll repeat again: If I read this correctly the problem is that unless the doctors are glued together financially, the corporation can't set rates, period. They have to use the messenger model. Each member of the IPA has to review each contract proposal and accept/reject individually. That means the IPA can't just say "We won't accept less than 110% of Medicare rates" even if every doctor has told them so. It still has to be passed along to each individual member.
If you want to know what fees others are getting without being accused of price-fixing, just start up an insurance company. They have a database where they share all of our fee schedules.
Also, don't let your group get too big because if you do then you will have too much market share and the FTC will break you up. Once again, if you are an insurance company no worries.
I recently finished residency and now I feel like what kind of mess have I gotten into. Looking forward to the next 30-40 years of this stuff is depressing.
BULL SHIT BULL SHIT AND BULL SHIT.
First the IPA cannot tell its members not to accept or decline a proposal. To stay out of FTC clutches the IPA does its best to negotiate the contents of the contract and then present it to each member to decide..... If the IPA members are smart they will do what needs to be done. There are plenty of stupid minds out there who will screw us all for a dime. We did this in our State and almost no one signed the contracts..... thats what the shredders are there for.
Time to go retire in Costa Rica and practice concierge medicine there. Most retirees there are willing to pay for quality service, and as I read Costa Rica was rated one of the best health care syatems in the World. That's because there is no cocky Govt. Beauraucratic assholes who are willing to let AIG pay Billions in bonuses even after they drove the entire world into bankruptcy.
I understand that we are spending too much and not gettng back enough on health care. Part of the problem is the unusually large sum of money spent in the last days of a person's life. The sad fact is that even though those dying are not enjoying these herioic attempts, the fear of lawsuit prevents most doctors from doing the right thing. If Mediare can set up some guidelines afer input from the specialty societies (not the AMA) as to when heroic measures can be discontinued, this will likely save a lot of health care dollars. Instead, our governent is trying to put the blame on the medical profession. I would estimate that a day's expenditure at the ICU would likely cover the annual health premium for a family of 4. There's no moral issue involved since everyone has the right to pay for the life extension if he so desires. Isn't it more logical to take care of the living instead of the dying?
Sermo Doc 69 that is why it is important for all of us physicians to band together. Do not despair, recruit your physician friends to join SERMO and Docs4patients. The more we are the stronger we are.
Look at number 11 on the Q and A portion of this posting. How much more do we need to take before we go on strike!!! rarmstrong and I are from Michigan and have been coordinating our efforts to recruit. In the past 2 weeks, I have recruited at least 20 physicians who have promised to look into joining SERMO and Docs4patients.
I encourage residents ,young physicians and even medical students to join the recruitment efforts because this is the future of our profession at stake here!
This country has invested in the past whereas China invests in its future. We will all take care of our own, patients will learn to barter, and the leaches that can't be weaned from the dessicated teat of government will perish.
Stock up on G&S and get out earlier than you originally thought.
And join the AAPS.
And for God's sake, can people just put their answer in the comments and not in the voting section. If you have an opinion, state it and own up to it with your anonymous screen name. Criminy.
in 2009 20 American trained Med students didNOT get into Residencies..!!! TRAGIC.. in my field there has been a decrease and we are fund raising to support training positions... BUT the insane part is FOREIGN trained are able to compete directly with AMERICAN students and block the americans OUT.. the Foreign trained have NO to minimal Debt.. THE americans HUGE debt.. and to add further fuel.. many med schools are PROFITING off admitting MORE MED STUDENTS who will be STUCK with DEBT and possibly not get into Residencies!!! INSANITY prevails.. CALL YOUR Med school and beg THEM NOT TO GET MORE KIDS INTO INSANE DEBT THEY WILL NOT BE ABLE TO PAY BACK!!. I actually listened to an eager premed student tell me last nite he has a friend in american med school who PLANS to leave USA for Africa and NEVER pay back DEBT... this too is insane and life decision NO med student should feel must make .........
back to this point.. Pres Johnson LIED to congress and cut premium and copay to 1/5 of KNOWN COST in 1965.. so it was predicted and came to pass MEDICARE RAN out of money in 1990.. The only solution is for mass effort to stop taking gov't med UNTIL THEY FORCE you.. more iimportantly EDUCATE the kids why they should NOT go medicine if they will have ANY UNDERGRAD or med school DEBT!! unsuccesstainable ..
sorry that number of american med school grad s who did NOT get placed in Scramble is 200 !! not 20 sorry go busy and did not get corrected soon enough
Sermo Doc 76 I believe that those 10 US medical students were dregs and you wouldn't want them doctoring your mom. Getting into and graduating from a US medical school doesn't make you smart enough, ethical enough, or diligent enough to be a good physician. Graduating from a foreign medical school doesn't prevent you from being smart, ethical and diligent.
also GREAT news.. the TEAPARTY express is having webinars to people with state of utah candidate promoting AAPS approach to get free of gov garbage.. but also are GIVING PHONE NUMBER OF AMA out and asking PEOPLE and DOCS to CALL the AMA and object to their position in health care reform (AKA Disaster...)
AMA number for docs and pt to call to object : 202 789 7400
also encouraging patients to ask doc to stop AMA Memebership and JOIN AAPS (American Association of Physcians and Surgeons) to try to free up Doc Patient Relationship and get rid of GOV and Insurance co and Lawyers between DOC and Patient!!
ps anyone know WHY the AAPS is of Physicians and SURGEONS ? my kid asked..which side did that ... the other fields or the surgeons?? aren't we all Physicians !! lol !!
Sermo Doc 4 Of course I want us to be able to live in a decent life style and be able to retire before we die and send our kids to college. I also want poor people to have access to health care. I don't think these are mutually exclusive. The insurance companies need to be regulated, not us. I don't believe that they are
Optics Many of our Foreign Trained DOCS ARE THE best and BRIGHTEST from their home country .. I KNOW THAT ./ the number is 200 American medstudents who are not getting placed .. but i still feel the AMERICANS should be given FIRST shot at American REsidencies so they can PAY BACK THEIR DEBT>. the foreign trained mostly have state paid training and do not have $400,000- $600,000 Debt . btw U of Michigan in their latest monthly mag stated that to keep the brightest and best in their home country so they can attend to the needs of their country U M is training Abroad!! has expanded training to abroad.. ps many of my collegues are foreign trained and terrific.. still the americans should get placed first..and if they are rotten NOT ADVANCED.. remember they have to pass boards too! ps my own Obstetrican and neonatologist and many subspecialties I see are FOREIGN trained.. MY issue is that amerian residencies should go first to americans with massive expense and debt.. . and why are there NOT more foreign residencies abroad?
colorlady , the Insurance companies are EXEMPTED from ANTITRUST and therefore can control their own turf.. this is why one main issue needing to be promoted is that Insuance be allowed to CROSS state borders.. since jobs are more movable now.. also i have personal experience in having International family coverage that was 100% ..but in past and now we have checked out med insurance in diff states.. for instance... NY HMO insurance is 5 times more expensive that FL PPO insurance.. and which state has more retirees .. ny insurance does not go to fl and fl insurance not go to ny.. except severe emergencies.. and then probably a fight to get covered.esp ny which requires you have you FP contact them when you are hospitalized outside of state.. hopefully you or family can do quickly !!so have a chance of some being paid
This IPA was asking to get stepped on. Completely illegal tactics. They should have known better. There is no such thing as a successful megagroup uberIPA. Forget that concept. The only large group that will work is for physicians to be employed by an entitiy, all under one tax ID and that entity can legally speak for its employees. As long as they are not a monopoly anyway. We were not succeesful with getting members on Sermo although I have seen that some are trying to set up single specialty groups. Go for it. This was an OBVIOUS violation.
orlando doc , i have known this catastrophe was coming but could not get DOcs or patients to care...so yes , CRISIS in life is Opportunity for GROWTH and yes, the crisis may actually save or destroy us.. but hopefully with our attempts to improve! first
I'm sure many of us have been involved in IPA's that involved all the doctors in one county....hardly an.... uberIPA....I'm just waiting for the steam roller to hit many more
IPA"s... in this particular case there was no one ins company that held over 50% of the health ins policies ....... so all the insurances companies were competing and were at the mercy of the IPA... had there been a BCBS or Humana or AEtna that had 50% or more of the market share of ins sold then the FTC would never of been involved because the IPA would have been impotent and the Ins co would have been the monopoly fixing prices....and the FTC won't go after Ins co given licenses to do business in a state by the insurance commissioner
dximg and the point on that lie is that 25 years later when Medicare ran out of money as predicted by the Insurance commission in 1965, the Government Blamed DOCS and New Technology for the reason Medicare ran out of money RATHER than the Truth.
in my world we were keeping patients out of hospital for recurring asthma atttacks .. so in fact we were saving money.. we had to go on to prove that for insurance to "justify" our great improvement in care!! and yes.. tonkin gulf indeed..............sad..
Nicole, it's not clear, but you seem to believe that my pointing out LBJ was, like many other Presidents, an inveterate liar, and even mentioning another example--the Tonkin Gulf claims that allowed him to lie us into greater military involvement in Vietnam--implies I somehow think his lies about the costs of Medicare were unimportant.
Of course they were important, and of course they had the baneful and baleful effects you claim. I believe I have made similar points on Sermo myself in the past.
Your last comment though, implying that lying us into a war that left 50,000 Americans and millions of Vietnamese dead is no big deal compared to lying about the tab for healthcare for elderly Americans...like Sermo Doc 56, I don't know what to make of such a seeming moral inversion.
I find it interesting that the FTC investigator into this IPA has singled out mostly Colorado IPA's. I find it even more interesting that the FTC investigator has a daughter that goes to University of Colorado Boulder. This IPA certainly allowed members to negotiate around the IPA contracts. In fact many members did in fact did in fact negotiate around the IPA's contracts and continue to honor these contracts. The IPA simply did not messenge RBRVS (medicare price based) contracts because RBRVS is a price fixed system that does not allow for cost of living adjustment. It is rumored that United Health Care is behind this investigation. Are doctors not entitled to get a raise on an annual basis. What other professional organization is never allowed to increase their annual wages. Don't let this fool you, this is big government siding on the side of those who pay for them to get into power. After $300,000 + dollars in legal fees, this IPA has simply run out of money to fight the tax funded government.
Bad lawyers--to get IPA into a historically unwinnable situation.
But basically: 1) World's greatest debtor nation
2)World's highest paid doctors
3)Medicare going broke/deficit burgeoning/cheap energy long gone.
You do the math--we ain't gonna win this one--
THE FACT IS THAT NOT ACCEPTING MEDICARE SOLVES NOTHING, YOU STILL ARE LIMITED BY THEIR RATES.MOST INSURANCE COMPANIES ARE CRIMINALS AND THIEVES,AND DO NOT PAY ON TIME ,IF AT ALL,AND THEN THEY REJECT HALF THE SERVICES OR DOWNCODE THE REST.MORE OFTEN ONCE THEY PAY THE MEAGER BITS THEY DO PAY,THEIR RATES ARE OFTEN BELOW MEDICARE,AND THE REST IS EATEN BY HIGH DEDUCTIBLES.DOCTORS NEED TO REALIZE THAT INSURANCE COMPANIES ARE THE ENEMY..THEY ARE NO FRIENDS OF DOCTORS. WE WOULD ALL BE MUCH BETTER OFF WITH A SINGLE PAYER SYSTEM.THEN, DOCTORS COULD ORGANIZE IN A POWERFUL UNION,AND ACT COLLECTIVELY AGAINST ALL THAT IS HORRIBLE IN THE CURRENT SYSTEM SUCH AS LOW RATES;THE INSANE TORT SYSTEM;THE UNENDING STREAM OF NEW AND UNFUNDED MANDATES ARRIVING DAILY FROM THE FEVERISH BEAUROCRATS IN WASHINGTON, SUCH AS NEW REGISTRATIONS OF UPIN AND NPI AND PECOS AND CONSTANT COSTLY AND TEDIOUS CODING REVISIONS,THAT SERVE NOTHING EXCEPT TO INTIMIDATE DOCTORS,AND MAKE THE AMA AND ALL THE SOFT WARE PROGRAM VENDORS RICH. MEDICAL DOCTORS OF AMERICA UNITE: YOU HAVE NOTHING TO LOSE BUT YOUR CHAINS!
Let us see. The govt has pulled this since 1987. So call me when you're ready for a one day work slow down or longer. Then and only then will doctors accomplish anything. Until then, grab your ankles.
Sermo Doc 80......after looking at the demographics of Garfield County CO
your observation sure makes sense.....a county with 50K people and 98 doctors
could hardly monopolize health care....How many IPA's has the FTC investigated in CO?
Is Fukitol legal in all states? The FTC has made a poor and illegal decision, but this cannot be easily challenged unless reversed by USSC or Congress. Pour me a bigger shot of Fukitol.
I saw Medical Economics had another blurb today about a Boulder IPA trying to circumvent FTC agreements. How much has the FTC been doing in Colorado to IPAs?
Roaring Fork, on behalf of its members, is prohibited from engaging in any collective contracting activities affecting rates in payer contracts. Roaring Fork is prohibited under the Order from:
(i) collectively refusing to accept proposed contracts for messengering with Medicare-based rates,
(ii) collectively asking payers to include a cost of living adjustment in the contract to be messengered, and
(iii) directing payers seeking information on the rates acceptable to members to look at collectively-negotiated I. P. A. contracts;
-----------------------------------------
Other complaints regarding Medicare against the IPA:
15. The Bona Fide Offer Criteria states, among other things, that Respondent will not consider any Medicare-based proposal to be a bona fide offer.
Respondent would not messenger offers with Medicare-based rates to its members because the offer did not meet the Bona Fide Offer Criteria.
The Best Practices identify a cost of living increase ("COLA") as a term that should be in Respondent's payer contracts.
19. By adopting the ban on Medicare-based rates, Respondent and its members agreed to refuse to deal and refused to deal with any payer using Medicare-based rates in a
proposed contract.
In a 2004 newsletter, Respondent told its members that it banned Medicare based rates because any physician who has Medicare-based rates in a payer contract would face "declining reimbursements."
24. Respondent also reinforced the concerted refusals to deal with payers except on its collectively agreed-upon terms by repeatedly reminding members in newsletters and other
documents that Medicare-based rates banned by the Bona Fide Offer Criteria would lead to declining reimbursement, and that Respondent's role was to "keep [members] informed of best practices," and the extent to which payers used its Best Practices in their contracts.
28. Respondent was highly effective in imposing the ban on Medicare-based rates and including the COLA term in payer contracts.
None of Respondent's current contracts has rates based on Medicare and all of its contracts have a COLA.
-------------------------------------------
28 just slays me - oh for goodness sakes - we have to accept a bad contract (% of Medicare) to avoid looking like we are breaking the law?
I thought accepting only good contracts was just good business.
---------------------------------------------
The complaint alleges that since at least 2003 RFV, although purporting to use a
messenger model, negotiated price-related terms on behalf of its members for the purpose of
increasing and maintaining the rates for services provided by RFV's otherwise competing
physician members.
RFV increased rates by demanding that payers include automatic annual
cost of living adjustments (COLAs) in their contracts.
RFV held lengthy bargaining sessions with payers to pressure them into including COLAs and other terms in their contracts.
To protect the automatic increases, RFV refused to messenger contracts with Medicare-based rates because of their potential to decline.
RFV feared Medicare-based rates would decline over time.
If we don't want to get fired as the ATA traffic controllers did, then we have only two avenues: (a) work at out slowest rate andterefore back up the ER, or bill for things MCR doens't pay for, such as telephone calls and filling out any forms, including explaining to an HMO why the generic drug just does not work. Your motto should be "no pay, no work" That's how the Tenafly teachers got their contract demands resolved: they refused to write any college recommendations (not in their contract.). We are so complicated that any rigid observance of the rules brings in massive slowdown. Trfy woirking up an ER patient with the full list of questions, and then add "do your teeth itch". do you feel that others are trying to communicate with you, and does your stool glow in the dark,.I predice 33% positive answers.
"...and does your stool glow in the dark,.I predic(t) 33% positive answers. ..." Tee hee
Sermo Doc 90 has a good idea -- almost better than a docs' day off thing. Just make a list of the irritants (disability forms, motorized scooter OKs, forms from ins co's re using a different drug, etc - pick and choose your least favorite) and then, for an entire month, simply refuse to complete them. Have office staff politely decline: "Our highly trained physicians aren't going to be involved with this s**t until they get the attention of everyone."
Cheap advertising. Lots of targets. Do it. Goal? Get their attention first; then start true reform.
Hmmmm, a massive doctor- owned insurance company??? Think about it, no anti trust issues, and we could run the show. Wouldn't that be something....in my dreams I guess.....
Actually, jbuford's idea makes sense, but the key would be to ensure that every patient is aware that every refusal to do something is because it isn't covered in the contract. Don't tell the patients "Our highly trained physicians aren't going to be involved with this s**t until they get the attention of everyone"; instead, tell them "Your insurance doesn't cover this request and we are unable to meet it."
When (if?) the insurers come to negotiate the items, open the negotiations with a demand for an hourly fee (or portion thereof...) for administrative tasks, and don't deviate from that demand. It's a good first step towards simplifying a contract so that you are paid on an hourly, rather than a diagnostic, basis.
The next step would be to per hour payment for all the time spent determining coding, and all the other admin crap the insurers dump on us.
This is old news folks. My response to all of the outraged is where have YOU been? If I'm not mistaken, these regs were in place when I finished training in 1990.
Here's how to fix the problem, ludicrous as it sounds.
1. Opt out of Medicare
2. Pass legislation to repeal Medicare. Medicaid can take care of the poor and disabled, including the elderly poor and disabled. All those with resources can get their healthcare the same way they get everything else they need. I.E. choose what to spend their money on based on perceived need and value.
3. Pass legislation to remove the tax free status for the purchase of group health insurance. The latter will melt away as soon as an incentive to provide that perk no longer exists and health insurance companies will be forced to compete for each individual's business, ala Geico and Progressive! Competition alone will put downward pressure on healthcare costs.
Yes. I know. Not very practical or realistic, but I can dream! Nevertheless, I DO believe that opting out of Medicare is a feasible, important, and necessary decision if we as physicians ever hope to feel as though we have some control over our future. The more difficult it becomes to find a provider, the more likely those with money and votes will begin to reassess "our" (the public in the form our legislators) decisions to create the legal atmosphere with which we (docs) are so disenchanted.
Pretty fascinating dialog on the post. I'm going to feature some of these ideas for my next FtF post. I'm also going to ask the Sermo Team to help convert the post into a press release (similar to what we did with the Mayo post). Both things should help raise the awareness around these issues.
This case simply illustrates the fact that physicians INDIVIDUALLY must come to the realization that accepting these rates is not in their best interest, but also not in the interest of their patients. These are the types of issues that casue burnout and early retirement from the medical profession thereby ultimately hurting patient care because there are fewer physicians to take care of them. If we as doctors eventuallly COLLECTIVELY make the decision not accept these kinds of rules, then we truly will have spoken as a profession and when those with Cigna (or whatever) cannot find a physician who will accept their insurance, the uproar will begin and these insurance companies as well as the federal government will have to stand up and take notice. Until then, we are all subsidizing the system.
my one time really engaged with negotiating, was with a snot nosed 27 yr old freshly minted MBA, who drove up in a Porche Carerra, and then started our little confab, telling me how I made too much money, and drove too nice a car, and it was his job to hit a target. I countered with one statement: "I hope you have an MD after your name, as your going to need it". I got up an left, sent word we would not be accepting their contract, and never looked back. At the time, that contract represented 60% of our work, but only 38% of our money. It was the correct decision.
I think the real rage stems from the fact that the playing field is so unlevel and so one sided. The power is all on the side of the insurance companies and with the government. There are no contract negotiations: for all of us, it is a simple matter of "take it or leave it". This has to end.
We do have the power to end this, and almost overnight, but it takes all of us acting independtly, and in concert. The insurance companies cannot and do not provide health care. They provide the means to pay for health care. Only we provide health care. It is time we recognized the power we have colllectively, and act on it.
It's unfortunate that the FTC and CMS have decided to go after the messenger IPA model, but groups have lost challenge after challenge over the past few years. The only model that really works for collective bargaining (other than unionizing, which I don't see happening) is what Sermo Doc 78 mentioned above: a corporation with a single tax ID that negotiates on behalf of all its physician associates and shareholders. The voting on contracts comes only from the board of directors, not from membership, so the associates have to trust the corporation's board. Moreover, the corporations' doctors have to be the majority in the area, but cannot be all the physicians (a monopoly), in order to have enough leverage to negotiate, not just with insurers but also with the hospitals. This addresses the FTC's statement that the physicians in the IPA are in competition with one another. Mayo clinic hasn't been accused of price fixing in this way.
An alternate way of accomplishing the same thing would be to promote ourselves as individual competitors in the market place as all our retail stores and gas stations do.
As an individual practitioner, I am going to take out a full page ad in our local newspaper announcing to all prospective patients and insurance companies exactly what my fee schedule is. They have been begging for transparency, so I am going to be the one to give it to them. I am still working out the exact details, but my fee schedule will be about 2 - 2.5 times what Medicare is now offering me for similar services. Of course, I may have to opt out of Medicare if they don't meet my fee schedule and will have to renegotiate with other vendors as their contracts expire.
The rest of you private practitioners will have to respond in a similar way to protect your market share and as individuals (obviously no collusion - we don't know each other and have never spoken) will have to "lower" your rates to match mine or risk having no patients. You may even have to take out competing ads trumpeting how you will not be undersold and even charge $5 less than me - ooh, I am hurting now. Let the competition begin...
I agree with Sermo Doc 7. The playing field needs to be leveled. The insurance industry needs to understand that without providers THEY HAVE NO BUSINESS MODEL.
My suggestion: PICK ONE SINGLE INSURANCE COMPANY AND HAVE EVERY SERMO PHYSICIAN INDIVIDUALLY DROP OUT OF THE PLAN
The criteria for choosing this company: 1. Have a fairly widespread or national presence 2. Be paying below market rates (which in NY state would mean all of them) 3. Not be a large enough player (less than 10% market share) as to adversely affect any individual practitioner.
If we can pick a likely target (such as CIGNA, AETNA or the Blues), and then get a critical mass of providers to stop accepting that one insurance plan, it is highly likely that we would be able to drive them out of business. No fee setting, no negotiations, no "collusion" ... just individuals refusing to continue accepting the unacceptable. And it could be done with minimal pain on our side.
Doing so would give the medical community the understanding that we CAN regain control of our fates. It would be the first step in establishing the collective will to say "no", and help us to join together to defend our profession. It would also put the insurance industry on the defensive for the first time in many years, and might even lead to more of a level playing field.
If this sounds like a palatable solution to you, post back. With enough interest maybe we could convince Dan Palestrant could take the reigns ...
It will never get better until we have the collective will to put all the insurance plans back where they belong: a contract betwen the patient and the insurance company, with the doctor not in the middle. Only the patient should be directly responsible for paying the doctor. We blew it when we started taking direct assignment about 40 or so years ago. and it has caught up with us with a vengeance. At the same time each and every one of us must make a strictly individual decision to out of Medicare. Will this happen? When pigs fly, because we do not have the collective will to do it. And things will continue to get worse and worse until we are all indentured servants of the government or have gotten out of medicine, if Big Brother will let us out.
I belong to this IPA, and the allegations made by the FTC are truely biased in their consent decree. Not mentioned in the report are that : 1.no physicians were required to join the IPA (about 70% join voluntarily) 2. the insurance companies can bargain outside the IPA with individual physicians and often made contracts with specialists with a RBRVS based reimbursement. 3. we did follow a messenger model and then the government used it against us.
So, for all of you out there the govenment is going to pick you off one by one unless you already are employed by a hospital, are a part of a cohesive medical community who can show that they collectively work together and therefore can bargain together, or already accept whatever RBRVS contract gets thrown in front of you.
So if this happpens to you do not hire a lawyer and waste your money, they are going to bust you anyways
All this is only possible as the Federal Government is at war against the sanctity of contract. This is going on since the enactment of the Sherman Act in 1890. The only valid contract in the doctor/patient interaction is the voluntary agreement between the doctor and the patient. The result is ever increasing oppressive Government power based on non-objective law whereby no-one can be certain in advance of any action by the Government against any valid agreement between individuals.
This is the arbitrary violation of individual rights that is guaranteed by the Declaration of Independence and the Constitution of the United States establishing the Government for the sole purpose of securing these rights. Government has become the oppressor. Let us uphold our inalienable rights and fight for the abolition of all non-objective laws as they lead us down the path into tyranny and dictatorship!
For additional information: Visit <www.ayrandcenter.org>
Is Fukitol a psychotropic? Maybe I could give it to my patients with anxiety disorders! Or at least my physician patients with anxiety disorders. Wonder if there's a generic yet and what tier its usually in. Hmmm.
I am a Foreign Medical Grad, Nevertheless, I see Sermo Doc 76's argument.
It is really dumb to get into medical schools if you are an American born/broughtup student. You will be saddled with Debt by the time you graduate.
Be Smart, Get your medical Schooling in India / Guyana/ Russia / Israel / Brazil,.... You will be considered an EMG, even though you are american citizen. But the advantage is that you will complete medical school at 1/4 th or even less cost of comparable American Medical School. Then come back for your rotating housemanship to US hospitals and Plan to take your ECFMG /USMLE in that one year. Of course, you will have to wade through the anti-non-american discrimination that routinely goes on in residency selections. (I still have letters from each and every program that I applied to over five years, that had the statement that 'we do not discriminate by nationality, race, creed, color or country of origin, yet in the main text of the letter, gave the reason for rejection as 'we only pick american students for our residencies and can not accommodate FMGs - May be I should sue them for hypocrisy and discrimination). Be ready to go to Alaska or Harlem for your residency.
You will come out smelling like a rose!!! with no debt.
Why on earth American Medical Grads refuse to go out of America and Practice? Go to Dubai, they will lick your feet and put you on golden pedestal if you are from Harvard / Mayo / Hopkins etc.
Of course, they will also cut off your ..... if you commit adultery or do drugs ;-)
Or you could choose to fall not too far away from the tree and get molested by government cuts in reimbursements and the barbaric laws being applied to doctors and medical practices in USA. .... which years ago, I thought was a fair and free country......
The insurance companies can collude to thier hearts content, but let physicians refuse to provide a service below it's cost of production, but one that the Fed insists you take, and you are breaking the law.
I guess the correct response is for the IPA to present the contracts to their members, but then no one signs them. Same result, and a stronger negotiating message.
I think the megaSermoIPA idea is moribund....
The consulting group that tried to shepherd us through the process had their lawyers present the legal case to us in detail. It's been too long to recall exact details, but there was a series of conditions that had to be met to qualify the IPA as an entity legally capable of negotiating for the group.
The FTC's complaint here is all about how these were actually COMPETING physicians acting in collusion. It would be interesting to understand if the FTC's consent decree against this IPA is because they have found an angle to disqualify ALL IPAs, or if this group just forgot to dot a few i's and cross a few t's.
"You're gouging on your prices if
You charge more than the rest.
But it's unfair competition
If you think you can charge less.
"A second point that we would make
To help avoid confusion:
Don't try to charge the same amount:
That would be collusion!"
Sermo Doc 11, you're giving me a headache.
I need more Fukitol. If they arrest us, will there be Fukitol in jail?
public.commentworks.com
IPA's have no real leverage if the FTC comes calling, since the members are usually economic competitors. Now, if all the IPA members were to create a fully integrated multispecialty group with genuine shared financial risk, they could accomplish what they set out to do.
public.commentworks.com
Comments due by Wednesday, March 3rd.
I'm no J.D.
But it looks like the IPA tripped up in several areas.
To be anything other than a messenger IPA you have to share financial risk or have significant clinical integration that demonstrates some kind of benefit to patients. Also, the IPA banned rates which were stated as a percentage of medicare rates and recommended a COLA (cost of living allowance) to be built into it's contracts. OF course the reasoning behing the ban on medicare based rates was very likel due to the SGR mess. The FTC appers to dislike this combo as it seemed to be a built in pay raise year to year.
I've seen this financial or clinical integration argument come up time and time again, so I think that provision is one to take VERY seriously with any other than a messenger IPA.
Sermo Doc 19
An FP dude in Austin Texas.
public.commentworks.com
Sounds like this case is headed for the courts - perhaps all the way to the highest court in the land.
There is a concerted effort to eliminate any form of third party messanger system to help the small physician entities gain any clout
We all should have organized 20 years ago, We have been divided and conquered, and just sat on our hands while it was happening.
This is one of the first signs of enslavement of Medical Professionals, Doctors specifically, both by the public and private sectors.
Some of us tried to get up and fight (Roaring Fork Valley Physicians IPA) and they were subdued.
What do we do next? This has got to become an all out battle! We're being backed into a corner by Government (both Republicans and Democrats) and by Insurance companies, with ZERO concessions being made to us.
We need a stepwise approach and a multi-pronged attack. We need to make a case to unionize. We need to make television campaigns, Youtube campaigns, billboards, commercials. We need to stir the pot, create some noise and get attention to point out, at least to the younger generations of what "they" do to people who work hard, pay up for education, to follow their dream of becoming Physicians.
Lastly, Sermo is not a catchy name. We need more visibility.
It goes to the heart of a fundamental contradiction that is inherent in our health care system in that physicians are expected to act like businesses - meaning that their expenses, taxes and tax structure, wages, proftis etc are their concern, and yet they are at a competitive disadvantage against BOTH big business and government in obtaining third party reimbursement. And no, you cannot negotiate collectively. As they say on the speed limit signs, It's the law.
My feeling is that healthcare will eventually become salaried and cash only/boutique. Absent general political will to level the playing field between private practitioners and big business, I just do not see private practice as a long term sustainable model, at least in this country
This is not news. The very same thing happened to Memorial Hermann HealthNet Providers in Houston about 4 years ago, after which the rates we were offered by all the Managed Care Plans went down. My practice income went down 11% and of course my personal income plummeted 22%. Now MHHNP has developed an integrated practice model according to FTC guidelines, but so far they have been unable to negotiate a single contract with managed care.
Let the FTC know this is plain un-American.
This should be a clear sign that the war against physicians is very real. It's time to bring it.
We already have a quasi-socialistic system where insurance companies, under the guise of HMO, PPO etc. set the price for service, regardless of each individuals need. there is no free market competition. What is the difference between HMO's and Medicare/Medicade? Nothing, they both screw the practitiioner as well as the patient. The only difference is who benefits.
JUST SAY NO.
If you start leaving participation with Medicare then we can argue that is not the market rate.
My advice to all new physicians. DO NOT EVER SIGN THE FIRST MEDICARE CONTRACT.
Once you do, you are INDENTURED FOR LIFE and you have GIVEN UP YOUR CIVIL RIGHTS - specifically your right to trial by a jury of your peers and your right to terminate a contract.
Do not let your residency program "obtain a medicare number for you." Do NOT SIGN ANYTHING with Medicare. Ever.
We can work for a corp run by suits or one run by white coats.
Choice is yours.
No one is going to do well in solo/small practice. Its just too much of headache to work for pittance that current rates are and it is getting worse by the day.
Chet, if we are really small businesses, how come are fees are fixed by our "clients".
Well, of course. Why then is it so hard to get anybody off the ass and join a new group? Docs4PatientCare is a new group - no bad baggage - only wants to help our cause - and there are people here who nit-pick the effort to death because of a NAME for the love of all that's holy! It. Is. A. Start. So join.
Join D4PC.
No, it will not relieve you from slavery but it is a step in right direction. So far, I have not found any baggage, either.
Another victim. The article helps explain government's rationale.
Seems to mean one has to tread carefully to avoid legal land mines, but apparently one can still get there from here.
#2. "Yes", I too am emotionally (but not cognitively) apopleptic;
+
#6. "Socialized medicine - its already here", at least in intent. That's why I've suggested the prospective options of either Mussolinian corporativism or Neo-Stalinism.
+
#7. "...Look to what other physicians have done in other developed countries when forced to accept unacceptable terms." The predicatory elipses denote the negation of proffered options of either litigation or unionization. Regarding the former option of litigation, the Feds have, for all practical purposes, unlimited legal resources & powers (especially given 20th century judiciary-created Federalization of 14th & 15th Amendments plus Lib-Left Earl Warren Federal expansionism). Hence, I personally doubt that the well-intentioned suggestions by peer Sermoans in this column to redesign corporate law for the benefit of clinicians will prove practicable without 'coupling' to legistlative power & action (a la the maligned AMA). Regarding the latter of option unionization, other Sermoans have pointed out various mid-20th century so-called anti-trust statutes that prohibit unionization by & for MDs. Seeing what MDs in other countries do is much more likely to be useful-not for purposes of either simplistic transposition (to USA) or simian mimicry (by USA MDs). Rather, US medicine should be like the late Meiji Restoration Japan--learn well from the virtues & vices of the technics of other developed countries & then adapt!
D4PC is the other part of our treatment plan, if emigration isn't.
Join D4PC, I did.
"What have I been saying - the government is completely out of control and WILL control you. Very soon medical licensing will be dependent on accepting medicare and you will be a serf to the government's whim. "
And as long as residencies are supported by CMS, this is bound to happen. In fact, I foresee in the not-too-distant future that acceptance into ANY residency will require signing an agreement that the physician will provide care for Medicare/Medicaid patients, if not as a condition of licensure, at least for a set period of time during and after residency.
If we want to do battle with Goliath, we need to make sure that he can't lay ANY claim to our slingshots and stones!
The problem is that this IPA, a collection of competing physicians and physician groups, failed to comply with the rules for a messenger-model IPA; they agreed as a group to set a minimum floor for commercial contracts. The fact that the minimum that they set was Medicare rates is simply coincidental; they could have just as easily (and just as illegally) picked a specific dollar amount. The problem is that these were competing physicians, and they therefore cannot collectively agree on minimum rates that they will accept; in order to comply with the messenger model IPA regulations, they must each independently set their own rates and the IPA must not facilitate sharing of fee information among members of the IPA. If they want to negotiate jointly, then they must become a group practice, not an IPA.
There is nothing in the ruling that prevents any individual physician, or any physician group practice, from refusing to accept Medicare rates from any commercial insurer; it simply enforces the laws that prevent competitors from working together to set prices.
I particularly appreciated the link to the analysis on Mises!
While not disagreeing with the thrust of your argument, nginn, there's no need to exaggerate. It is no more possible to yank a privilege faster than Obama can spend money than it is to yank a privilege faster than light can travel...
Democracy dies when the voters "in charge" have zero intelligence to use their vote wisely.
The founding fathers had it right when they said you had to be a property owner to vote.
Oh we are in serious trouble!
Game over man, it's just game over... pass the Fukitol my way, too.
Sermo Doc 14, you sound like your lithium dose needs adjustment :)
ftc.gov
Unless the insurance industry's antitrust exemption is eliminated (by Pelosi of all people), you don't have a chance.
Looks like it is time for some civil disobedience.
Yes it was naive, but if it works for animals, maybe it can work for humans.
Gave up Medicare about 6 years ago-all in one day-boy do I breathe easier.
Kinda like what Nixon said ,
"it's not illegal if the President does it!"
If you want to know what fees others are getting without being accused of price-fixing, just start up an insurance company. They have a database where they share all of our fee schedules.
Also, don't let your group get too big because if you do then you will have too much market share and the FTC will break you up. Once again, if you are an insurance company no worries.
First the IPA cannot tell its members not to accept or decline a proposal. To stay out of FTC clutches the IPA does its best to negotiate the contents of the contract and then present it to each member to decide..... If the IPA members are smart they will do what needs to be done. There are plenty of stupid minds out there who will screw us all for a dime. We did this in our State and almost no one signed the contracts..... thats what the shredders are there for.
Time to go retire in Costa Rica and practice concierge medicine there. Most retirees there are willing to pay for quality service, and as I read Costa Rica was rated one of the best health care syatems in the World. That's because there is no cocky Govt. Beauraucratic assholes who are willing to let AIG pay Billions in bonuses even after they drove the entire world into bankruptcy.
Yes Sir, let DC folks enroll in Medicare.
Look at number 11 on the Q and A portion of this posting. How much more do we need to take before we go on strike!!! rarmstrong and I are from Michigan and have been coordinating our efforts to recruit. In the past 2 weeks, I have recruited at least 20 physicians who have promised to look into joining SERMO and Docs4patients.
I encourage residents ,young physicians and even medical students to join the recruitment efforts because this is the future of our profession at stake here!
Stock up on G&S and get out earlier than you originally thought.
And join the AAPS.
I thought you were moving to Finland?
back to this point.. Pres Johnson LIED to congress and cut premium and copay to 1/5 of KNOWN COST in 1965.. so it was predicted and came to pass MEDICARE RAN out of money in 1990.. The only solution is for mass effort to stop taking gov't med UNTIL THEY FORCE you.. more iimportantly EDUCATE the kids why they should NOT go medicine if they will have ANY UNDERGRAD or med school DEBT!! unsuccesstainable ..
AMA number for docs and pt to call to object : 202 789 7400
also encouraging patients to ask doc to stop AMA Memebership and JOIN AAPS (American Association of Physcians and Surgeons) to try to free up Doc Patient Relationship and get rid of GOV and Insurance co and Lawyers between DOC and Patient!!
ps anyone know WHY the AAPS is of Physicians and SURGEONS ? my kid asked..which side did that ... the other fields or the surgeons?? aren't we all Physicians !! lol !!
You should post only before: 14 cups of coffee/methamphetamine use /cocaine use /MDMA use /loss of lithium with subsequent rapid cycling.
See the Caps Lock? Don't touch it.
BTW, "unsuccesstainable" is not a word.
I know to many of you this simple one line statement will be very puzzling, but this is what will save this country.
Amazingly, Nicole, not Pres. Johnson's only lie to Congress...(see Tonkin Gulf) :-)
IPA"s... in this particular case there was no one ins company that held over 50% of the health ins policies ....... so all the insurances companies were competing and were at the mercy of the IPA... had there been a BCBS or Humana or AEtna that had 50% or more of the market share of ins sold then the FTC would never of been involved because the IPA would have been impotent and the Ins co would have been the monopoly fixing prices....and the FTC won't go after Ins co given licenses to do business in a state by the insurance commissioner
in my world we were keeping patients out of hospital for recurring asthma atttacks .. so in fact we were saving money.. we had to go on to prove that for insurance to "justify" our great improvement in care!! and yes.. tonkin gulf indeed..............sad..
[Sigh] Sad indeed...
Of course they were important, and of course they had the baneful and baleful effects you claim. I believe I have made similar points on Sermo myself in the past.
Your last comment though, implying that lying us into a war that left 50,000 Americans and millions of Vietnamese dead is no big deal compared to lying about the tab for healthcare for elderly Americans...like Sermo Doc 56, I don't know what to make of such a seeming moral inversion.
Why must you always be the cat batting around the mouse? :-)
This is in connection with the above posting
Anyone want to comment before March 2 ?
But basically: 1) World's greatest debtor nation
2)World's highest paid doctors
3)Medicare going broke/deficit burgeoning/cheap energy long gone.
You do the math--we ain't gonna win this one--
we should be running the show
Mandated insurance mandates insurance profits without insuring patient care or doctor payments
i cant believe that so many are still playing the game AND LOSING!
your observation sure makes sense.....a county with 50K people and 98 doctors
could hardly monopolize health care....How many IPA's has the FTC investigated in CO?
(i) collectively refusing to accept proposed contracts for messengering with Medicare-based rates,
(ii) collectively asking payers to include a cost of living adjustment in the contract to be messengered, and
(iii) directing payers seeking information on the rates acceptable to members to look at collectively-negotiated I. P. A. contracts;
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Other complaints regarding Medicare against the IPA:
15. The Bona Fide Offer Criteria states, among other things, that Respondent will not consider any Medicare-based proposal to be a bona fide offer.
Respondent would not messenger offers with Medicare-based rates to its members because the offer did not meet the Bona Fide Offer Criteria.
The Best Practices identify a cost of living increase ("COLA") as a term that should be in Respondent's payer contracts.
19. By adopting the ban on Medicare-based rates, Respondent and its members agreed to refuse to deal and refused to deal with any payer using Medicare-based rates in a
proposed contract.
In a 2004 newsletter, Respondent told its members that it banned Medicare based rates because any physician who has Medicare-based rates in a payer contract would face "declining reimbursements."
24. Respondent also reinforced the concerted refusals to deal with payers except on its collectively agreed-upon terms by repeatedly reminding members in newsletters and other
documents that Medicare-based rates banned by the Bona Fide Offer Criteria would lead to declining reimbursement, and that Respondent's role was to "keep [members] informed of best practices," and the extent to which payers used its Best Practices in their contracts.
28. Respondent was highly effective in imposing the ban on Medicare-based rates and including the COLA term in payer contracts.
None of Respondent's current contracts has rates based on Medicare and all of its contracts have a COLA.
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28 just slays me - oh for goodness sakes - we have to accept a bad contract (% of Medicare) to avoid looking like we are breaking the law?
I thought accepting only good contracts was just good business.
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The complaint alleges that since at least 2003 RFV, although purporting to use a
messenger model, negotiated price-related terms on behalf of its members for the purpose of
increasing and maintaining the rates for services provided by RFV's otherwise competing
physician members.
RFV increased rates by demanding that payers include automatic annual
cost of living adjustments (COLAs) in their contracts.
RFV held lengthy bargaining sessions with payers to pressure them into including COLAs and other terms in their contracts.
To protect the automatic increases, RFV refused to messenger contracts with Medicare-based rates because of their potential to decline.
RFV feared Medicare-based rates would decline over time.
Perhaps the FTC hasn't seen...
www.ama-assn.org
www.oregon.gov/OHPPR/OHREC/Docs/.../JeaneneSenComm03_06.pdf
Sermo Doc 90 has a good idea -- almost better than a docs' day off thing. Just make a list of the irritants (disability forms, motorized scooter OKs, forms from ins co's re using a different drug, etc - pick and choose your least favorite) and then, for an entire month, simply refuse to complete them. Have office staff politely decline: "Our highly trained physicians aren't going to be involved with this s**t until they get the attention of everyone."
Cheap advertising. Lots of targets. Do it. Goal? Get their attention first; then start true reform.
When (if?) the insurers come to negotiate the items, open the negotiations with a demand for an hourly fee (or portion thereof...) for administrative tasks, and don't deviate from that demand. It's a good first step towards simplifying a contract so that you are paid on an hourly, rather than a diagnostic, basis.
The next step would be to per hour payment for all the time spent determining coding, and all the other admin crap the insurers dump on us.
Here's how to fix the problem, ludicrous as it sounds.
1. Opt out of Medicare
2. Pass legislation to repeal Medicare. Medicaid can take care of the poor and disabled, including the elderly poor and disabled. All those with resources can get their healthcare the same way they get everything else they need. I.E. choose what to spend their money on based on perceived need and value.
3. Pass legislation to remove the tax free status for the purchase of group health insurance. The latter will melt away as soon as an incentive to provide that perk no longer exists and health insurance companies will be forced to compete for each individual's business, ala Geico and Progressive! Competition alone will put downward pressure on healthcare costs.
Yes. I know. Not very practical or realistic, but I can dream! Nevertheless, I DO believe that opting out of Medicare is a feasible, important, and necessary decision if we as physicians ever hope to feel as though we have some control over our future. The more difficult it becomes to find a provider, the more likely those with money and votes will begin to reassess "our" (the public in the form our legislators) decisions to create the legal atmosphere with which we (docs) are so disenchanted.
Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.
We do have the power to end this, and almost overnight, but it takes all of us acting independtly, and in concert. The insurance companies cannot and do not provide health care. They provide the means to pay for health care. Only we provide health care. It is time we recognized the power we have colllectively, and act on it.
As an individual practitioner, I am going to take out a full page ad in our local newspaper announcing to all prospective patients and insurance companies exactly what my fee schedule is. They have been begging for transparency, so I am going to be the one to give it to them. I am still working out the exact details, but my fee schedule will be about 2 - 2.5 times what Medicare is now offering me for similar services. Of course, I may have to opt out of Medicare if they don't meet my fee schedule and will have to renegotiate with other vendors as their contracts expire.
The rest of you private practitioners will have to respond in a similar way to protect your market share and as individuals (obviously no collusion - we don't know each other and have never spoken) will have to "lower" your rates to match mine or risk having no patients. You may even have to take out competing ads trumpeting how you will not be undersold and even charge $5 less than me - ooh, I am hurting now. Let the competition begin...
My suggestion: PICK ONE SINGLE INSURANCE COMPANY AND HAVE EVERY SERMO PHYSICIAN INDIVIDUALLY DROP OUT OF THE PLAN
The criteria for choosing this company:
1. Have a fairly widespread or national presence
2. Be paying below market rates (which in NY state would mean all of them)
3. Not be a large enough player (less than 10% market share) as to adversely affect any individual practitioner.
If we can pick a likely target (such as CIGNA, AETNA or the Blues), and then get a critical mass of providers to stop accepting that one insurance plan, it is highly likely that we would be able to drive them out of business. No fee setting, no negotiations, no "collusion" ... just individuals refusing to continue accepting the unacceptable. And it could be done with minimal pain on our side.
Doing so would give the medical community the understanding that we CAN regain control of our fates. It would be the first step in establishing the collective will to say "no", and help us to join together to defend our profession. It would also put the insurance industry on the defensive for the first time in many years, and might even lead to more of a level playing field.
If this sounds like a palatable solution to you, post back. With enough interest maybe we could convince Dan Palestrant could take the reigns ...
So, for all of you out there the govenment is going to pick you off one by one unless you already are employed by a hospital, are a part of a cohesive medical community who can show that they collectively work together and therefore can bargain together, or already accept whatever RBRVS contract gets thrown in front of you.
So if this happpens to you do not hire a lawyer and waste your money, they are going to bust you anyways
This is the arbitrary violation of individual rights that is guaranteed by the Declaration of Independence and the Constitution of the United States establishing the Government for the sole purpose of securing these rights. Government has become the oppressor. Let us uphold our inalienable rights and fight for the abolition of all non-objective laws as they lead us down the path into tyranny and dictatorship!
For additional information: Visit <www.ayrandcenter.org>
It is really dumb to get into medical schools if you are an American born/broughtup student. You will be saddled with Debt by the time you graduate.
Be Smart, Get your medical Schooling in India / Guyana/ Russia / Israel / Brazil,.... You will be considered an EMG, even though you are american citizen. But the advantage is that you will complete medical school at 1/4 th or even less cost of comparable American Medical School. Then come back for your rotating housemanship to US hospitals and Plan to take your ECFMG /USMLE in that one year. Of course, you will have to wade through the anti-non-american discrimination that routinely goes on in residency selections. (I still have letters from each and every program that I applied to over five years, that had the statement that 'we do not discriminate by nationality, race, creed, color or country of origin, yet in the main text of the letter, gave the reason for rejection as 'we only pick american students for our residencies and can not accommodate FMGs - May be I should sue them for hypocrisy and discrimination). Be ready to go to Alaska or Harlem for your residency.
You will come out smelling like a rose!!! with no debt.
Why on earth American Medical Grads refuse to go out of America and Practice? Go to Dubai, they will lick your feet and put you on golden pedestal if you are from Harvard / Mayo / Hopkins etc.
Of course, they will also cut off your ..... if you commit adultery or do drugs ;-)
Nevertheless, explore the world markets.