Al,
I like everything you said except for the lack of a strike. I am a member of organized labor and without the right to strike you are a toothless tiger my friend. They hurt cops and teachers with this garbage all the time. They get hit with the loss of two days pay for every day out on strike. Now that is BullCCHIT.
Let the docs who are on staff as management man the ER's at the hospitals for crisis care while the majority are out on the picket lines. Let them try and bribe some scabs who will be scared to cross the line or know that their own names will be mud if they do. Let them force the slave residence to cover everything. It is the loss of revenue, loss of customer access to the product or service that finally brings both sides to the table, plain and simple.
If you can't actually leverage back, then what reason does the other party have to come back to the table and negotiate "In good faith"??? None what so ever, trust me on this one. The history of labor is full of examples for this. Recently I was offered a job as a labor organizer with the new teamsters doctor's local here in CNY and I balked because I need to keep this place going for my wife and family. Some times I want to kick myself in the butt for this as I really think this is where I belong. I actually took organizing courses years ago down near you at the George Meanie labor center in Maryland. Again I don't say this lightly. We are consumers of healthcare too. But without both sides being able to leverage the other with financial losses then things never seem to move along. That is the real purpose of the strike. The withholding of services until we can work things out.
Two: I really think it is time for specialties such as all PCP's and other mostly office visit specialties to have their own unique fee schedule that gives their E&M codes and other office visit type things a relative value that is equal or better than the highest valued procedures. We all know that this is where the rubber meets the road. It is the FP like my wife that has multiple issues and meds to balance and deal with that take over half an hour plus paperwork to do, that under the present coding system one can't even get $100 bucks for here in a region like ours, even from comercial payors. What garbage. We need a separate fee schedule for the specialties that have no real surgeries or other high paying procedures to balance out their bottom line.
We almost have no Diabetes specialty groups to send hard to maintain and treat patients to anymore around here. Almost all of them have closed up shop and the last one or two are booked 4-6 months out! These Endo guys are just like PCP's in that most of their work is in low paying E&M office visits yet this is where we save tons of money for everyone by saving people and their body parts from failure and death. It is time to put up or shut up. The last Endo group to close shop claims they lost $300K over the last few years and had no choice but to close their doors. And this for caring and giving high quality time consuming care!
And on this we need a law that mandates the payment for any and all paperwork, referals, prior auths, even Rx's. Same with any and all forms for anything, school, work, what ever. Writing an Rx is not a mindless matter. It is the actual thought about patient and conditions and other meds. The faxing, calling, mailing and all the rest. No lawyer wouldn't think of billing folks for their para-legals time and their interactions with that para-legal.
Think about it... Why do we do tons of uncompensated paperwork for all these people? It is my contention that once the carriers actually had to cover the cost of what they push and shove on us, they would start thinking twice about how and what they ask for. As long as they can mandate that it be done for free, then they will continue to ask for the sky and beyond.
