Home Forums Discussions General Discussion The War on Physicians...

Doctors are from Mars.
IT guys are from Venus.

I'm not quite sure what this is supposed to mean; neither do I understand how it is germane to the discussion.

This is a brilliant statement putting it all down in a nutshell. I hate to act like there is one problem, but ONE of the huge problems is ignorance. (I don't mean the term in an arrogant way). I have over 60% Mainecare and am the largest pediatric solo provider of Mainecare in Maine except for the FQHC who makes three times as much. I don't bring it up, but when it comes up in discussion, my Mainecare patients are completely flummoxed (as George would say) what the reimbursement is. They also cannot believe that the FQHC makes nearly $100 for the same patient visit I get $27.00 for.

Meanwhile we have a Preferred Drug List, which means I have to struggle to get a CP patient with a trach glycopyrolate or Xopenex for a congenital heart patient. Yet, my three patients with Mainecare can go to the ED at 2PM, because it was closer to their house. I also can charge the allowable charge for record transfers for all self pays and privately insured, but I cannot for Mainecare.

There was a group of OB/Gyn in New York area who tried to fight the insurance companies and the Assistant Attorney General struck it down in court and then went on to say, "I have saved the consumers from the greedy physicians."

I think the problem I alluded to above is that the American people (I know that sounds cliche, but it is true) have no idea how the insurance system works and especially the socialized part of it. They don't know how the ED sees patients for colds and flu when they should be seen much cheaper. They don't know that the system works with privately insured, because there is a $100 copay at the ED and a $20 copay at the physician's office. All they know is that medical expenses keep spiraling upwards but not why.

The key is for awareness. The country moved forward because Martin Luther King brought awareness to the issue of illegal and immoral segregation. More awareness was shown due to the million man march. And, part of getting out of Vietnam was due to the many protests of the 60s. We have been in Iraq far too long, but how much longer would we be there if there were no media coverage.

I bet if you gave a 100 question test to all of the congress people in Washington, three of which questions would be what is the reimbursement for A) Anthem, B) Medicaid and C) Medicare; most would flunk miserably. And, ask them if Dr. X charges $110 per 99213 and Dr. Y charges $100 per 99213, who would make more money at the end of the day for ten 99213 visits. How many would get that right?

From my vantage point the increasing costs of health insurance has nothing to do with the cost of physician reimbursement, but rather the increasing need for insurance companies to show "quarterly profit growth" every quarter.

Every doctor out there knows they are not being paid more. The insurance companies MARKET "socialized medicine" as some type of dastardly effort by the government to control how healthcare is delivered, when the reality is there is no greater CONTROLLER of the delivery of healthcare, than the insurance company:

They decide which doctor you see.
They decide which hospital you go to.
They decide which diagnostic tests to authorize.
They decide which procedures to pay for.
They decide how long your hospital stay is.

They do this with their eye on their next quarterly earnings report. The sooner they get out of the healthcare equation the better for the healthcare system.

Of course you don't. That is the point

Did you actually have something to contribute to the discussion?

Obama cannot tackle health care reform right now. If you reduce the bureaucratic overhead and put about 750,000 more people out of work, we may be close to a full depression.

And yet, to decrease the costs in health care, we must decrease the administrative costs.

Drugs, in this country cost as much as the care for Primary Care Physicians.
Specialists earn twice as much.
Administration is somewhere between the two.
Hospitals in this quadrangle make a greater percentage, but given their multifaceted role (some diagnostic, some treatment, some housing, some bureaucratic) this is not surprising.

Currently my state, Illinois, is on the verge of bankrupcy. Part of this is because the former governor, Blagoyevich tried to provide coverage under medicaid to low income adults without the means for the state to pay for it (seems he was no better at finding money for himself, or was he.)

We have to have one set of rules, prices and operational definitions on which to operate. This is most easily done through SINGLE PAYOR, but that could be state or regional wide. It does not have to be a direct governmental agency, it could be Blue Cross of the Midwest (hopefully not BCBS IL they have their issues) And I agree we need some type of collective bargaining or negotiating power and NOT through the AMA (doesn't that also stand for against medical advice?)

Wendell, I'm not sure how, but I know Docs, especially primary care Docs, need a real voice at the table, which will represent their real interest.

I agree with Wendell and George. My practice consultant sets up my checks for my bills, and I sign them after reviewing them. Every time the Penobscot Medical Association tries to hit me for $50.00 worth of dues, I have to rip up the check. Barbacues and picnics for its members really does nothing to benefit the physicians.

It is sad that with the state medical assosiations, the AAPs, AAFPs and AMAs, etc. we don't already have collective bargaining.

Build it and they will come.

Leslie

I don't want the government as a single payor. Medicare fraud and administrative waste are horrendous. If you change your practice address, Medicare holds up your payments for months. "HCFA-for-all" is exactly what the problem doesn't need.

The patients need to be involved in, and at risk for, payment for the services they receive. Everyone who is not living on the street can pay something. For the employed, the best model might be an HSA, where the patient "owns" the first several thousand dollars of the premium, to spend as they need and desire, and beyond that is covered by insurance. Some of my patients have this, and they aren't demanding chest x-rays and MRIs for every complaint, or asking me to write them a medical statement to continue their expensive brand-name sleep med.

The less fortunate will need some type of subsidy for the patient-controlled portion, but there must be some patient ownership of the payment process, and some risk. Only then will patients look for physicians, hospitals, etc, which can compete by efficiency, quality and value. The role of the government is ONLY to provide clarity on prices, ratings (not by insurers, but by other patients and professionals), all the info they need to choose. It wouldn't be that hard to get something like this operating on a small scale tomorrow, Mr. Obama.

What we have now is a system like what caused the sub-prime mortgage meltdown -- our patients are buyers with nothing down, nothing to lose.

Very nice, John. I too have seen a big difference in expectations and demands from those patients with HSAs. And, going one step further, perhaps the government could assist those without insurance by supporting and expanding inner-city and/or regional clinics (such as Planned Parenthood)that would provide total primary care and some specialty care. I am sure they could hire docs to either work full or part-time or moonlight there. Provide money to medical schools and nursing schools and dental schools in exchange for their services in staffing similar clinics. There are so many things that could be done without socializing the entire system.
Also, perhaps we should send Dr. Mostashari a link to AC.

Leslie

OK, I know nothing of macro or micro economics, so I will probably say something stupid, but I think that the time to get rid of bureaucratic overhead is always now. I would think let capitalism work.

Here are two excellent summations of the problem at hand. They are long but poignant.

http://fee.org/nff/healing-america-the-free-market-instead-of-government-health-care/

http://www.thenewamerican.com/usnew...lthy-government-healthcare-may-be-coming

Leslie

These were new websites to me...thanks for sharing. Many people come at the health care topic in different directions and it is good to read them all to gain a broader perspective.

this discussion was thought provoking enough to prompt me to outline my thinking in this area in detail. I'll post a link to my summary as soon as I have it on my website.

Here is my attempt to pull together a plan on the "War on Physicians" issue. I appreciate any feedback.

http://www-personal.umich.edu/~ebeeman/Healthcare_thoughts.pdf

Those were really great articles

please remember a big cost to the physician and the system-defensive medicine and torts. If we are going to take care of the pot holes, better off repaving the road.