I just had a big blow out with Nancy over a patient/friend who wasn't cooperating with his own very needed care with regular visits. And we have another patient who wants to switch her soboxone therapy from her present shrink to Nancy because she is her PCP, but the big pay-off for this treatment is on the front end when they start, not in the long term treatment and you can only have a max of 30-40 pts the first year with a max of 100 on your panel at any time. So we were arguing over only new pts or perhaps making them pay cash for the first few est'ing visits regardless of who started them... Why do I bring this up you ask???
Because my point is Just how much does the pt value any of you and your better more personal, more acessible practice? At what point and how much? Are they willing to put their money where their mouth is? Let them walk if they don't care to to pay you a living wage or cooperate with their treatment. Heck kick 'em out! You guys should all live on a hamster wheel while starving your ethics with no support or apperciation? Granted some folks are truely broke, but even those people seem to have cell phones for every family member, cable TV, money for smokes or drinking night, but they can't afford to pay their doc a few bucks.
I am tired of seeing supposedly broke and on public healthcare people walk in the door with $50 nails and hair jobs. We have a family on Medicaid who drives nicer cars, newer cars than we do... It is bull, at least some of the market needs to be put back into this. And all that garbage lobbying that we were talking about in our EMR PM needs to be exposed too. Why is the AAFP and the AAP not totaly tearing the AMA apart on the RUC that sets the relative value units that congress almost always uses (lobbying at it's best, inside committee recommendations) for office visits so low while taking care of their specialist friends at the expense of primary care and other high time spent, personal service, office visit based practices like chemo, endo, and primaries???
We are attempting to take the slowly weed them out approach and see how this works. It seems to have worked for a number of other IMP's. Get rid of the really bad paying ones or the ones that waste you and your staff's time with lots of bull and paperwork first. It is almost better to accept $5-$10 less a visit to not have to do any hours worth of prior auths all the time for every med and every referal, think about that one for a moment. So keep the better paying one and the ones that leave you alone and don't bother you. Use them as you balance out your panel again. Try to reach out to lots of PPO like patients that can stay on regardless of model because they have some out of network coverage. These are the ones who some will stay later on. The start weeding out the ones you kept for a while.
The way I see it is the patients and the plans all use you guys very badly all the time, it really is a very bad and broken model where everyone is trying to take advantage of the other. So return the favor in a way that at least is more favorable for you. Use the carriers as a temporary life raft to your new business model and then when you don't need them anymore ditch them. It is treating them just as they treat patients and doctors.
They try to cherry pick and ditch sick patients all the time, so you do the same with sick contracts and carriers, that just business. It is not your fault that somebody's employer picked UHC over some other carrier, you too must survive to fight another day. And honestly, you can not help anyone else until you are half safe and on solid ground, you owe it to yourself and all your patients to keep your practice on a solid footing, viable and sustainable and if that means using the rules on the old messed up model to your advantage then so be it. It is not only about the individual patient, but about the health of the doctor and the entire practice for all the patients that really matters. And that is why these twisted do good, but don't actually do what they claim to do, treat or charge everyone equally rules don't work. In the end they don't allow the doc to care for the entire panel or practice and they never actually have everyone being charged or treated the same as they claim to do. They only really serve the corporate SOB's, the carriers so they get the best deal. I threw that one back at our local BC once, I said to the lady, I don't want to say no to anyone, it is your terrible policies and contract, fees and the like that turn your patients into untouchables. We'll gladly see each and everyone of them once you treat my doctor better for caring for your patients.... Who is really mistreating and being treated unequal in all of these matters????
Anyone who wants you to starve and be ill from the stress of living on the edge like this, just how much do they really apperciate you and your time, your knowledge and skills, your access and person service??? Let them really apperciate you. And if they balk, ask them if they have a cat or a dog and then ask them what they plan to do if Fido or Whiskers gets sick tonight??? Checkbook or Visa anyone????
She should have gone to Cornell.....
Paul
