Home Forums Discussions General Discussion Good article from Medical Economics

http://tinyurl.com/6cjx97

This is a good article that pertains somewhat to this topic. If ALL of her suggestions were implemented tomorrow, I think health care would be 300% better.

I totally agree with the points

Oh boy, don't get me started. Suffice it to say, as a small business owner and a physician, whoever gets elected may well put me out of business. I could not help but chuckle during the debates about the push for EHR and putting health records online...."the VA has done it for years". Yea right. And who do I have the most trouble gettng information from??? THE VA. Until we get people in Washington thinking outside the box I have little hope for the health of our health care. The only saving grace about McCain's plan is that it may lead to the downfall of employer-based payment for health care. Ok, I'll stop.

Leslie

And, I agree with Leslie. I think until we have business and health care people making these decisions in Washington, it is never going to be fixed. At least correctly. It just seems that the people that run Jet Blue, Google, or other people who have turned around businesses that were prior running in the red should be involved. Even politicians who are well meaning have no way of knowing how to really fix health care.

My guess is if you polled every politician in the Congress and Senate and asked them what the reimbursements were for Medicaid, Medicare and the private insurance companies and asked them what primary care providers make compared to other specialties, they would fail the test miserably.

Just my two cents, which given the current financial crisis is probably only worth one cent if that.

I also love the way the state of Maine handles budget shortfalls on Medicaid. Rather than cutting back on Medicaid (which I understand is not good for those patients), they simply stop paying for all vaccines for private and self pay patients. That's quite the novel approach and is also sure to increase vaccination rates.

Missouri is playing around with the idea of HSAs for Medicaid patients. The patients will be required to "save" a certain amount before their benefits would kick in. In theory I like it, in reality, the care will just end up in the ER rather than a "medical home".

I find it unbelievable that in Maine we have this incredibly difficult Preferred Drug List, which in its defense is the most successful in the nation and does save the state hundreds of thousands of dollars yet no one at the state level will make any difficult decision on the use of the ED.

People (doctors and patients included due to the frustration of the system of the PDL) will make the somewhat understandable argument that by not allowing a script for Aciphex now will only cost more in the long run due to admissions secondary to out of control esophagitis. In actuality, this is probably not true. The director of the frustrating but incredibly successful preferred drug program (very similar to some private insurance comapany's but at a much more extreme level) will basically say he doesn't care about increased ED visits or hospital admissions; he only cares about his role in the savings of prescriptions. While this may sound cold and harsh, he is in his own unknowing way, correct.

All patients should have a higher copay at the ED than they do at a doctor's office visit including those on Medicaid. I, for one, am rather tired of hearing the argument that if a Medicaid patient were turned away from the ED due to inability to pay, there would be medicolegal implications due to any bad outcomes. But, private pay patients face the same decisions when it comes to a decision between a higher copay at the ED and a lower copay at a physician's office. And, I know that Medicaid patients don't have copays at the ED, I am just proposing that maybe they should.

I get ED reports constantly on my patients who went to the ED at 3PM, 5PM, 7PM, etc. for cough and sore throat lasting five days. This is a ridiculous use of the ED.

The only problem with adding copays to Medicaid is that they would mostly still utilize the system, but just not pay their copay - "i forgot my wallet", "I will bring back a check", I can't pay today etc. I see this all the time in the office and mostly just get burned on this - we have a basic health plan that pays Medicaid rates plus 15 % or so with a $15.00 copay, some number of these pt. always have an excuse and unless I get really strict and don't let them come in without a copay - they abuse us and don't pay their bill.

Adding a copay just means more write offs on our bad debt - really doesn't help the system.

Steven,

Agreed. We are in the same boat. That's why I think for the ED problem to be solved, some tough decisions would have to be made.

Ironically, it is far easier for an ED who has no relationship with a patient to simply refuse to see the patient (once we accepted that there would be consequences for some of those) than it is for you and I to turn away a patient for lack of copay that we do know and just have a hard time turning them away.

Missouri has a copay for Medicaid $2. I was advised from the beginning not to even try to collect.

Unbelievable.

Advised by whom?? That's the most ridiculous thing I have heard and, personally, if we physicians continue to play the patsy we will continue to be abused! I quit taking Medicaid 5 years ago. I refuse to be a part of that "ask for an inch and take a mile" philosophy. As far as my private pay patients, if they do not have their copay, they are not seen. Period! (unless it is an emergency). They are told it is their insurance company's rule that the copay must be paid at the time of the visit. Surprising how many patients will suddenly remember they left their checkbook in the car and then run out and get it. If a patient absolutely cannot pay that day we will gladly reschedule for another day. If I know the patient well and they have a good history of paying their bills, I might go ahead and see them but tell them they need to bring the copay back later in the day or tomorrow. And it is I that tell them this, not the front office person. When I look them in the eyes and tell them it is much more effective. If we have to send a statement to collect a copay, there is a $5.00 charge. That info is posted plainly in the waiting room. Now days, this is rarely an issue because my patients have been trained to know that they have to pay up front.
You youngsters need to get tough or the system will eat you up.

Leslie

You are right. I face the tiger everyday.

Leslie,
I cannot begin to thank you for all that I have learned from you here and in many of your posts.
Unfortunately, I'm not young, I'm just not well informed and have always been an employee until this year.
Thanks

But, we are all young at heart Vicki.

I can't follow tinyurl. It never works. (for me),. But i went to Memag's website and I think I saw the article. It is good. But it won't help things their. He needs to send it to Barack Obama, John McCain, his Congressman and his Senator. Just for starters.

Vicki,
You are welcome. We all were inexperienced at some time. I just have a real problem with physicians feeling like they cannot stand up for their rights, as business people, as teachers, and as masters of their craft. NEVER assume anything. Always question. Don't let anyone try to pull the wool over your eyes. I know many times I come across as a hard-long-eared equine and, if you push me, that's what you will see. But, early in my solo practice I defined the things I hated about group practice (the ineffectual meetings, the inefficient physicians and office personnel who were sapping the profits and stealing my precious time out of the office, and the demanding patients that have no respect for me or for my profession) and I made it a point to change those. Whereas my previous partners bent over forwards to please the insurance companies, the lawyers and the rude patients, I refuse to do so. I treat my patients with the utmost respect and dignity and will do just about anything for them.....if they show me the same consideration. I will fight even the most miniscule point if I feel my patient's rights are being infringed upon or if I sincerely believe "it just ain't right". Subsequently, over the years I have attracted a practice full of patients I like and who like me. Those that don't go elsewhere and we are both better off (although as Bert and I have discussed previously, it still hurts me when patients leave. I really am a softy at heart).
We physicians got ourselves in this mess and,somehow, we have to get ourselves out. If we refuse to unionize then we have to do it singularly but, en mass. I was one of the first to ditch our regional physican-owned managed care "manager" because they were taking 2% of my collections but doing nothing for me I could not do myself. Once I dropped out, so did many others. I was one fo the first to stop doing Paps on Humana patients at the time of their annual exam because they insist on bundling it. (I make them come back another time for the GYN exam.) Others in my community have now followed suit. The point is, do not be afraid to buck the system when your gut tells you it "just ain't right". You might be surprised how many docs are out there just waiting for someone to make the first move.

Off my soapbox for tonight

Leslie

When is the next union meeting? Maybe we can hire Sally Field.

http://www.imdb.com/title/tt0079638/

LOL,
I thought about a stat I never have verified. During one of the doctor strikes in LA, the mortality rate actually dropped.

Leslie, I didn't see your words of wisdom before I pushed the reply button.
I am too old to build a crummy practice. We're only 6 months old and we're already full in the sense that we are booked solidly for two months and the next new pt visit isn't till Februarty. I do hospital too so I am really pushing myself. It helps because the outpt reimbursement is so bad.
As hard as I work, I want patients that I enjoy because we too go above and beyond for them. I have decided to have my office manager do a preliminary interview with them and get a med list before I take any more new ones. Your previous screening questions have been so helpful.
Thanks again for everything. You and Bert and thers on these boards have helped me soo much.
Blessings Vicki

Hello Leslie
I read your recent post--who is "regional physician-owned managed care manager"? is there someone with that title with every managed care? I'm eager to know.And how exactly did you ditch them?I'll be starting my solo practice early next year and every little advice will help.
Rachel

There was a doctor strike in LA? I would so want to do that. Sorry for the teenager lingo; it just seemed appropriate there.

Rachel,

When managed care first came to my area in the 80's a large group of regional doctors banded together to build a contracting association that supposedly would have more power to negotiate with the insurance companies for reimbursements and other issues. I would say 99% of the local physicians belonged to this group. If an insurance company wanted to bring in new plans or cut services or reimbursements or sign up participating doctors they had to go through this association. In exchange for the association managing your contracts, you contributed 2% of your collections from the companies that used the association to sign you up. Sounded great in theory and worked for many years. Then the insurance companies got so big (by eliminating the competitors) they really did not need to listen to the doctors' group. Susequently, the group had less and less ability to modify insurance company behavior but we all just kept handing them our 2%...for years. I finally got fed up and realized it was stupid and did not renew my contracts through the association. I found I was getting the exact same reimbusement rates when I contracted on my own as I did when I gave away 2%. Others soon realized this also and dropped out and the association crumbled. Maybe it would have been better for me to work with the association to enhance their negotiating leverage but, I am not a "meetings" or committees kind of person, which I guess is one reason I love solo practice.
So, to answer your question, "No" there are not "managed care managers" with every insurance company. My advice would be to check with your county medical association and see if there are any bargaining groups in your area, read the fine print, and perhaps use them if available to at least get your feet in the door and your practice up and running. Then later scrutinize every contract, keep a close eye on your reimbursements from each and start eliminating those that are not up to snuff (not that any really are). A very wise mentor of mine used to say "I would rather sit in my office and twiddle my thumbs and not get paid as to work my arse off and still not get paid".

Good Luck!

Leslie