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No at times you all really work more with all the uncompensated managment of care that nobody pays for or repects. Try that with your lawyer. "Oh I just want the doctor to call, I need to speak with her for just a minute". They hit the chess clock right after hello how are you?

As I tell everyone, our business is just a conduit for "other" people's money. we don't really get to see or keep much if any of it. But boy do all those specialists want to make sure they've got their "referal". But they make sure that the contracts make a mockery of the relative value system by having fee schedules that pay them "more" for the exact same codes you PCP's get burned on every day. So Let's say Nancy does a skin Biopsy, she will almost certainly get 10% or more less than a Dermatologist does for the same exact code with the same exact plan!!! No less that most PCP's live and die by the level 3 and 4 E&M code for the most part, with some CPE thrown in for good measure. Ped's having a few more than FP's I would gather. Meanwhile the specialist have all sorts of procedures and surgeries to make more money in one day than PCP's make all week. I think PCP's need to demand fees that pay them about 25% more for all E&M codes, allow for any and patient managment in 15 minutes sections, including charges for night call, just for getting paged at 2 am.

When was the last time the CEO of UHC got woken out of bed or dragged out of their kids school play because someone else's kid was throwing up or someone elses mom had fallen at the assisted living place while going to the pot?

Check this out because this is the type of commando tactics that work in labor situations. There was a local that during Ted Turner's non-union (IATSE, the Stagehands Union) filming of the Civil War movie that kept making for a lack of "Quiet on the Set", by flying an old style prop bi-plane over the battlefield with banners trailing behind in the shot frame no less "Hire Union Today". It was great!

So anyway, I think we should get the private numbers of all the CEO's of our health plans and call them and wake them up everytime we get paged. "Oh hi there Mr. Dontgivearatsass, just wanted to let you know right away because you are so concerned about patient care that little Joey Smith is running a temp of 104.2 and can't sleep or hold anything down. Do you have a pen and paper, that's patient ID Number 123XYZ456, subscriber is the father, Joe Smith Sr, DOB: 03-03-1968. They have HMO Blue Options that needs prior auth for everything. Have a good night sir." We'll see how long it takes them to find a "value" for such things then. Much like when Michael Moore on TV Nation put the garbage trucks running and slamming outside the rich private homes of the guys who owned the garbage hauling companies at 4 am? Let then live with their own bull$&*! I need to get some more work done around here. Be well.

Good Night and Good Luck
Paul

HAHAHAHA!!! I bet there would be some fur flying if you and I and Bert ever got together somewhere for a few Heinikens!!

Leslie

Leslie,
What is it about you and Bert and Heinies??? I want a great New England Brew Like Catamount Amber or Sam Adams. Sounds great. When, where???
Paul

Reply to Apricot, you CAN create a superbill without finishing or even starting a note. At the bottom of the drop down in superbills is CREATE A NEW SUPERBILL. Just fill in the blanks.
Nancy Blake

Hey, if you grew where I did you'd think anything not brewed with Ohio River water is nectar for the Gods. (Ever have a Sterling? Tasted like trolling motor oil or catfish dung.)

Leslie

Yeah I lived in Burlington, Vermont (you know the whole $160,000
medical school thing) and I could never develop a great taste for Catamount. Sam Adams, sure. But, after living in Seattle for four years, I grew a little tired of the microbreweries.

The thing about Heinekens is the progress drop in minutes to drink: First beer: 10 minutes, Second: 8 minutes, Third: 4 minutes, Fourth: 1 minute, Fifth: I can't remember.

Paul, your writing is just great. I think we need to go 48 hours or 60 minutes to do an expose. But, it would probably take 48 hours and not just 60 minutes. The problem is 100% of America knows about global warming, while only 1% knows aobut how screwed up reimbursement is.

How many of you would "really" be willing to help fund an informational group or PAC, that's only job would be to hit the media regularly, so as to inform the general public of our bankrupcies, over-load, anti-free market, and plight? We need to attact this on a national level and it would probably take all of us, hitting our various local media outlets, combined to pressure at a federal level regularly to finally make a real dent in the lack of public awareness. "Primary Care Physicains for Economic Equality and Reform... Yeah that's almost Pecker's isn't it??? lol).

The other thing is that we would need get our story striaght and make sure that a good part of it shows the public why hurting us really hurts them. We now don't have enough endocronology here in the Syracuse area for all the diabetics that need their services. The latest office to close says that they lost $300,000 in about that last 3 years and so had no choice but to close their doors. This is because the gave real care, took real time to see their patients and did lots of uncompensated work.

I think it is time for a primary care based organization that represents the real day to day hard workers like you folks. I feel that most of the state medical societies and the AMA don't care enough about PCP's. They care about specialists and maintaining the old broken system that allows certain high paid specialties to not PAR and keep this broken system going. So at some point very soon you guys need your own real champion and public support for change that includes you! Healthcare reform is on the public agenda but who is getting your side of the story out and speaking up for your needs? Trust me you don't want this big nasty thing getting "reformed" without having your voices heard and represented at that table. Goodness knows what that'll look like. "Oh we'll just finance reform like we do Medicaid, on the backs of starving and broke PCP's and other care providers"; trust me....

I don't really see anyone doing the right thing on any of this, do you? Do you think that the AMA is really going to get you guys a real "bump" in your E&M codes that are PCP only or finally create and get Medicare to pay for codes tha cover, getting paged and providing talk care after hours, all your phonecall, review and discussing and explaining labs time??? Try calling your lawyer and not have the chess clock start ticking, right?

Even the local Teamsters here were trying to simply win the right to organize and collectively bargin here in our state. But those of you who saw my post from the AAFP article about the FTC totally emasculating that GYN union, know that we need a new FTC and federal legislation that defines and protects your rights against these large greedy monsters. So what if you have a local union, if the moment you actual start to flex you collective muscle the FTC comes right in and shuts you down??? The only way that any of this is going to change is with a large public ground swell of support, and we better grab this opportunity now while it is on the greater public psychie.

So, are you folks really ready to waste your one spare evening a week, and your last few spare (do you have any left?) dollars on getting on this? Each one of you, your own local rep who needs to knock on a lot of doors, have them slammed in your face and come back for more???? we'll create a good stump speech so the message stays on target might we say.

Nancy does a small weekly peice on various health topics here with our local NBC affiliate on the lunch time news broadcast. I just got her to agree to talk about the closing of the Endo group here and their loss of $300K and how this affects real patients. That she needs to use her bully pulpit now and again for this. She started saying the public won't buy it because they think you're all rich. I told her to have them take a picture of our rusting out, 181K miles, '98 Grand Cherokee with the mismatching red door on it's green body, with it's missing front bumper. And that car was bought for us by my mom the widowed retired school teacher bought us when we had our first kid so the kid wouldn't be in a bomb of a '72 Plymouth Scamp that we used to daily drive back then. We couldn't then, as now afford such a car ourselves!

How can we organize and pull this off? I think it's gonna have to be grassroots. Doctor to doctor like on this board. You guys need to make friends with other stressed out docs in your areas, let the drug companies feed you now and then to make new friends and get reaquainted with old ones, and do this person to person, one at a time. Anyone really game? I'm scared I just got myself in over my head, because Bert is gonna want me to lead the charge....HEEELLLLLLP!!! Are you folks game???

Good Night and Good Luck
Paul