Home Forums Discussions Feedback and Recommendations Improvements: Co-pays and imported items

1. Please make the co-pay entry available prior to the superbill completion. As of now you can't enter anything until the doctor completes the superbill. We collect our co-pay when the patient first signs in so the staff has to keep a separate list for co-pays then re-enter it after the doctor complete the chart. Double the work and prone to entry errors.

2. The imports sections should also have a sort by date instead of just category.

This is a source of irritation for me. I really wish we could input the amount of paid copay at arrival and have it automatically show up on the invoice. Currently, we have to keep a separate Excel log, and the Dr. has to input the copay on the invoice when she codes it.

This is something I've voiced last year when I started using the program.

1. You have to sign up the chart and THEN go back in to log copays in the spread sheet. I now have our receptionists go in and log copays after I've finished the charts (I was doing it).
2. You cannot apply any kind of payment other than copays and have it show up in the balance.
3. I've been assuming (!) that perhaps this is there for an eventual PM module.

Barb,
Read the threads "Superbills" in problems and a kind of old one, "Bad Math". This has been a real bone of contention for Nancy and I for quite some time now. Let me know what you think. And everybody, please for your own sake, go read the EULA once more....
Paul & Nancy

Inability to create a superbill without finishing a note is irritating, but it helps to comply with Medicare guidelines.

I had used NexGen for several years. NexGen allows to create superbills and enter copays w/o finishing notes. As a result, up to 30% of our office notes were left unfinished. Now 100% of my office notes are finished by the end of each day.

I wish import section had "Hospital Records" folder. I keep dischage summaries and H&Ps there.

Just to be able to record the DOS and the collection of the Co-Pay, while the superbill or invoice is still outstanding is a real must. We have just started to collect co-pays upfront (and boy does it help to keep from getting stiffed) and it would be so nice to just record them into AC, where eventually the copay on that DOS can get associated with and tied back to the encounter the doctor will chart later would be great. Right now we print the schedule out and hand write all the copays onto it next to the patient's appointment which then I then later enter into QuickBooks. It tracks it but wouldn't it be so much easier and cleaner the other way?

We use Excel to write down copays, but I don't enter daily copays in Quickbooks. At the end of each month I download my monthly transactions from the bank website and import then to Quickbooks. Then I assign an account to each deposit/withdrawal. I spent less than 15 minutes for bookkeeping every month.

OK, I SHOULD have gone to bed two hours ago....

Copays are moving.. and based on our meeting with Jon, they'll be captured when the patient is checked in and matched up by date later when the superbill is created. This is subject to change (the spec isn't cast in stone yet), but regardless of the final design the copay WILL be collectible when the patient checks in.

It's coming...

Now that it's pushing 2:30 AM.. I AM going to go to bed.. more updates tomorrow, folks.

V.

We just started our office this week and am glad we are not alone on the co-pay issue. We are in a different bind because we set a $25.00 office visit fee instead of co-pay. Can we set it to say visit fee instead of co-pay? Any news on that.
Thanks.

Folks,
Temporary suggestion of what we are doing. We print out the days schedule which then sits up front. We collect the copays before the visit. Then Shele or I record who paid what and how, next to the patient's name; Like $25 Cash or $15 Ck # 123 or what have you. Later on I enter these in our quickbooks as we have every patient set up as customers. We also have a "flow sheet" for every patient that we enter things like refer to Dr. X, copay, the copay info and the like. We all refer to these and they only get shreaded after all the tasks are done, like reminder set, referal complete so and so forth.

Also, I have spoken to Vinny who uses a good PM program (Medisoft 12 I believe?) and has all the data re-entered manually. He and I are both of the belief that having a 2nd person re-enter the data really works as a continual chart/billing review type system. Evey now and again I flag one or two things I talk to Nancy about. I'd 75% of the time we don't change a thing because most of the time she did everything just great, but it is a regular chance to keep on top of things and review how and what we are doing. In this business one can not be too careful. So as much as I too originally really wanted some sort of "e" connection to just send things over from charts to PM, more and more I'm really liking what we are doing just fine. Yes it is a bit more time consuming, but double checking almost every claim that goes out the door has it's advantages too.

Hey! Dr. Vinny! Does Medisoft 12 have an export to quickbooks function??

Our biller is planning on upgrading from and old version (really old) to V12. I want her to export our data and email it to me so I can import it into Quickbooks. Is this possible?

Wayne

Wayne,

I have NO IDEA! LOL. I don't use Medisoft in house, I use Lytec, and I don't use Quickbooks!

Sorry I'm not much help....

V.

oh well.

Guys,
Sorry that was my mistake. But are not those two programs owned by the same company? Are they similar?

Anyway, the whole idea is I sort of by using patients' initials in proper order for every patient, seen every day, spliting the page into 5 dated columes,Maonday thru Friday, I can track each and every visit and bill, I fill in the amount charged (when I get the invoice from the doc's charting that is), copay collected, cash or check. Now I know any one invoice I did or didn't get and whether or not to hastle my provider about it or not... It's less than perfect but almost. It is a bit time consuming but at least I know I'm getting each and every visit for each and every day. Nancy and I check off the completed days, and weeks and it allows her to look and see what she still has outstanding to catch up on. Now I know for certain. Sure I wish I could do this ala computer report style as you and I have requested, but until then this really does work. And with only one or two providers it shouldn't be that bad. We are "capturing" just about each and every visit at least and that's real bottom line stuff....

We collect the copay before the visit and keep a daily spreadsheet of all patient payments at the desk. I might start looking at that as a way to track the # of actual visits we had in a month.

Wayne,

I updated Medisoft from v6 to v12. It has not been a smooth transition. The database from version 6 will not covert to the newer version. Technical support will not help correct the conversion. I get error messages (which is annoying). In addition to that, technical support has the gall to state that the database is "corrupt" (and therefore not covered under technical support). I have paid an additional $400 after uploading my database to them (and they held my data hostage until payment). After going through all of this, the database continues to produce error messages. After a few thousand dollars of trying to update Medisoft, I'm planning on moving on to another software.... Version 6 worked much better.

One of the many reasons why I don't do business directly with NDC Healthcare. We had a problem with Lytec, and they pulled this "your database is corrupt - send it to us with $300" bulls**t. Fortunately before sending it to them, I did some nosing around and found the "change log" for the update we'd loaded.. and this wasn't a corrupt database - it was INTENTIONAL BEHAVIOR. There was nothing wrong with our data. Their answer to EVERYTHING is "your data is corrupted, send us money"

Can you find a Medisoft VAR in your area? They generally have much more of a clue than NDC's technical support department, and they MAY be able to get you up and running, as the problem you're having upgrading they've probably found, and fixed, a bunch of times already for their other clients.

Good luck, Roy. I feel your pain.

Regards,

V.

Our biller (we outsource it but so far she's ok) wants to update from Medisoft (oh, 5 or 6 i guess) to Medisoft 12. I will pass on the advice to her not to go through NDC. I did have the contact info for one VAR. I might still have the email she sent me.

Be sure you add to your contract specific languange. After going through the abuse with Per Se, I would insist on adding performance language on my contract such as, "The purchase price includes successful updating of the database from Medisoft 6 to Medisoft 12 such that the database works without producing error messages. If support is needed for coversion of the database, this will performed within ___business days. Purchaser (or his designate), when calling support will get a support technician within 15 minutes of call, otherwise, purchaser will have the right to charge $___ /per hour in increments starting at 15 minutes for being put on hold to speak to support technician."

Interesting language. I'll pass it on to her. It really makes me not want to ever use Medisoft though. But I understand Lytec isnt any better. Has anyone used AltaPoint?

No but I've been looking them over most of all while sitting on the fence about what to do and how to leave our present billing company. It seems like a very good and well thought out program. Very flexible too if you are willing to play with it for a bit, especially in terms of creating your own types of reports. But then again, I've never done billing, so trying to shop for a product is kind of less than perfect. But the lady who would probably take over our billing situation liked it almost best of all. In the end, she personally picked an ASP program for her other customers because that solved so many tech issues for her. But you all know how I feel about ASP's and anybody else who tries to hold your data hostage, so even if we hook up with her, with us we will be using another program. Originally we were trying to wait for Amazing PM or whatever it's going to be, but we'll see how that eventually evolves.

Isn't it amazing how providers have all these issues just getting paid for the services they provide, that they studied so long to learn, aquiring loads of debt along the way and yet nobody gives a darn about how we get the short end each and every day? Don't you just love our present and past FTC? Sorry, it just makes me so mad. No other professionals get to be treated this way.

You should hear my latest story. OK, you twisted my arm so I'll tell you. We have a new podiatrist working in our office. But his main office is in the Bronx w/ alot of Russian immigrants. He said that apparently, in Russia the doctors don't seem to have been respected too much, or maybe its just misunderstanding the US system. He's not sure. But he frequently has new patients tell him that no, they don't want to pay their copay in advance (which he requires, just like we do). They want to see the doctor and evaluate how they are treated. Then, they will DECIDE if they will pay the co-pay. WTF?

Gee, I wonder if my local Shell station will let me have my gas first, evaluate the mileage I get, and if I'm satisfied, then pay?

The best thing I have done was put up a bright florescent sign that said "Co-pays due at the time of service, NO EXCEPTIONS". My receptionist tells me she has had no further arguments.

Have a great day,

Barbara

Bright Flourescent, yuh? You and I must be alike some how. Yes the Co-Pays in advance is our new policy too, but it's the carriers that make my blood boil. No other professional that I can think of has to be bargined down, by some other 3rd party that has less than perfect intentions towards both the professional or the end consumer, our patients. The "Free Market" arguement that is used against providers falls apart right there. Unless we par with this 3rd party then we can not have free access to the covered lives in their plans. The consumer goes to those who par. Unlike Autobody shops and food stamps. The customer still have free choice to go where ever they really want.

I was just thinking about this, this morning. We should get paid more in a "Food Stamps" kind of way. Sure you par with food stamps, but the consumer gets to choose where they shop, based on whatever reasons they care use, and the store still gets to charge whatever price they see fit, based on market forces for their products or services. Unlike us, the food stamp stores don't get told that they "may" or "may not" get paid even if they did make a sale and they still get to charge all customers the rates that they themselves set based on the previously stated market rates. These stores don't get told that they must charge the food stamp customers $1.00 for the gal. of milk that they charge everybody else $2.50 for, so that they end up lossing money on all their food stamp customers. Now at least that is almost a real free market. You just can't charge them more, but you can charge what ever you deem appropriate and all customers truly get charged and we truly get paid the same no matter who walks thru the door.

I think it's a great analogy, because both are gov't programs that assist poor and disabled folks get something important that we as a society all agree that they need help getting. Why can't we be treated at least as well as an F'ing Super Market??? Is that really asking so much, for folks who went to Med School and Residency, who gave up 8-12 years of their personal and professional life to aquire the skills they need to perform their important jobs, while missing out on at least a middle class level of pay while studing during that period of time?

I'm sorry, but if we had this to do over again, I think Nancy and I would be much better off as two High School teachers. Full pay, full bennies, pension, and our summers off with our kids!!! Think about that for a moment. Right now I could be in my Jeep teaching my kids great things at Yellowstone, the Grand Canyon and a bunch of other great places and experiences, with summer pay. Talk among yourselves...I'm too P.O.'ed.

"Good Night and Good Luck"
Paul

Hockey-- aren't you describing, essentially, the old Indemnity Insurance model. We had a (yes, ONE ) patient with an indemnity plan. He could go to ANY doctor. They paid something like 80%, then we billed him for the 20%. We wish we had more patients on this type of plan.

Oh my gosh...now I really do feel old!! 80/20...was the standard when I first started. (And, try to do a barium enema as an outpatient...NO WAY!!! You had to admit patients to get one done.) Now you guys have barely heard of it. Anyone out there remember Elvis???
I'd better get back to my rocking chair. I am depressed.

Leslie

OK, as I just told Roy and Paul, I know very little about billing. But, what I have learned has come from being the IT person at my last practice before opening my own.

We had very good support through NCD for Medisoft. Maybe that's because the data got corrupted every other month. Seems like anytime the power went out even though every PC and the server were on UPS/AVRs the data did something funny. But, they did get right on the phone with us. 6.0 yikes! Again, I don't know, but our biller would have quite if we made her use 6.0. Hey...maybe looking back...

When I opened up here, my practice consultant didn't even give me a choice. It was eMedware from Sage given they were so cheap. And, they are a lot less money than the big boys Medisoft and Lytec. It seems to work rather well. The scheduler isn't that great. But, then again, schedulers are always an afterthought on every PM and EMR.

The biller who set my office up and works across town loves eMedware and their support. But, I had an experience like Vinny's. We had an issue with a little bit of data. So, she talks to support and support fixes the problem but tells her the problem was my network was very, very slow and that she should tell me to hire a consultant to "look at therouter." Well, besides the fact that the router doesn't affect the network's speed when using a switch, I doubt our network is slow with 4GBs of RAM on the servera and a GB on each station with dual core processors and Cat6 cable, etc. I definitely wrote a long email to the supervisor. I doubt anyone thinks I am capable of writing a long email. <G> But, I digress. My only point is he should have asked to speak with the IT person so he could explain why he thought that, etc.

But, besides my ego being bruised, it seems support is rather quick.

But even with traditional indemnity these SOB's get you to negotiate down your fees to the agreed upon rate. I'm talking real free market that the customer gets some or all assistance for. We all set our charges based on our own freemarket thoughts and needs, and supply and demand. We then charge and get paid truly the same from everyone no matter who they are or what form of payment method. With my local BCBS traditional patients there is still a difference between my charges and what they will pay and we can not by law or by contract collect the difference between our charges and the strong armed "Argeed Upon Rate".

Again just think about the gallon of milk and Food Stamps. You're downstate, right? So Walbaum's charges everybody $3 per gal for milk no matter who they are. And they all pay $3 a gal no matter who they are, right. So whether cash (Private pay), credit (different private insurance), or Food Stamps (Medicare or Medicaid,let's say) they all pay the same and at time of service too.

No cash, credit or food stamps in hand, no milk, to bad. It's up to the gov't to supply the right amount of food stamps for any person or family, for those who need it based on whatever formulas they choose to use. Hopefully they actually observe the cost of living and what things cost. But we the providers, just the the Supermarkets right now, don't get asked to assist in the financing and proping up the broken system by making us accept less for the same services or products.

Nobody in their right mind, even on food stamps thinks that they should be able to walk into Walbaum's and walk out with a gal of milk (baby food, very important) without cash, credit or food stamps. And again, it's the finally being able to charge and actually "get" a market based rate and charges for our services. Then we charge what we want to and let the customer shop where they will for whatever reasons they have, be they cost, convienence, service, quality or what have you. I don't care what your insurance is because I charge and get paid the same no matter what, based on my reasons and the market my business is based in.

BUT, Once we all PAR then we all cost exactly the same, right? We all watch our fee schedules and remits and set our rates based on the rules of the game as it presently stands. So, all the patients pay all PAR docs the same thing for the same services in the same part of the country or the state. Just where the hell is the "free market" in any of that? It's a bold face lie and we all know it. But, the FTC is in bed with our pols and the carriers and keeps getting this very wrong. And gov't continues to write laws that only make this all even worse.

It can't really be a free market until we can charge and get what we charge in full at time of service. Only when nobody is allowed to PAR, can it be considered a real freemarket. The way I see it, the present system is really a form of gov't supported price fixing against all of us. In the same town, if we both PAR then the local BCBS will pay us both exactly the same and not a dollar more. And it costs the patient exactly the same then too. If that's not reverse price fixing against the merchant then tell me what is? Come on, please....

If a Supermarket can be treated with at least this amount of respect then why not a licensed provider of medical services?

"Good Night and Good Luck"
Paul

Hey guys,
We still do have some traditional indemnity plans here. Especially with our BC/BS and mostly 80/20 like you said. But the rub still is that they set one fee schedule for the entire region, just about county by county. I was going to tell you all more about how the local Blues controls things and how backwards they treat us, but some of the info I didn't post might have gotten me in trouble for collusion for sharing this privilaged and confidential information. Leave it to say, they call all the shots and everyone in a certain area all get paid the same fees in the same specialties. Real Free Market there, right. "Oh but we have the right to starve and walk away from their boilerplate contract and fee schedule, even though they control our free access to our end customer, the patient." I forgot how free I was, silly me....

And although the AMA that we shouldn't support any more, supposedly saved us all from the SGF cuts, somehow Upstate NY went down in many places anyway, based on geographic reason and others. Like it's cheaper to practice medicine in upstate NY in 2006 then it was in 2005, and again the same from 2006 to 2007.... I kid you not. This is real. We get paid less to send a doctor to your aging mother's bedside at an assisted living facility today in 2007 than we did just a year ago in 2006! We're talking a bedside, housecall for goodness sake. I beg your pardon.....Oh but we did get a small bump on some, not all regular office visit E&M codes like the rest of the country did this year. In many respects, after reiviewing the fees for the last few years, we have only now half returned to the fees that we started with back in 2004-5 when we first opened... "Free Market Anyone?" I've got to go get some work done before we starve here.... Talk among yourselves....
"Good Night and Good Luck"
Paul

You're preaching to the choir, Paul. And, a divided choir at that.

Paul,

I could not agree more with you and have used the very same milk analogies. The basic problem, however, and the one that separates healthcare from everything else is that our liberal, do-gooder politicians have brainwashed us into believing "It is a right!" I guess that implies having a roof over your head, food in your belly and clothes on your back are not. When I first started in medicine in 1975, as a PA in a small Kentucky town, my doc and I frequently accepted sacks of tomatoes, country hams, hand-made pillows and fried apple pies as payment for services. Patients would barter with us. They needed medical care, we needed a fence row cleaned out...both sides were happy. The patients did not expect something for nothing. Try that today and Medicare would be on you like stink on s%#t because you would be giving away care to some but not to all. I can't tell you how much fun and satisfying medicine was in those days. My happiest days now are when I go out to see my Amish friends, provide some medical care to a family and come home with a side of bacon or a hoof trim/shoeing for one of my horses. Many times I have considered leaving my city practice and becoming an country doctor for the Amish settlements near by...driving my horse and buggy to their houses. Problem is, my mortgage lender won't take bacon as payment on my house loan.

Leslie

Ya know as much as I think as the richest and strongest nation in the world that we should find a way to provide quality care for all our real and "legal" citizens (Canada does not provide care for illegals last I looked) nothing says that PCP's and others took an oath of poverty just for the privialge of providing that care. My Brother Josh is a Psychiatrist and before he died my dad saw Josh become a private practice shrink and Nancy half way thru med school. He was a liberal lefty Jew for the Bronx. But I always remember what he said about why all docs deserve a certain amount of decent pay.

Basically he said nobody remembers how many years while studing and training that these folks who are obviously very smart in Math and the Sciences, missed out on making, saving and investing money for their own future; 5-10 extra years of real lost income to become high quality doctors between, pre-med, med school, and residency. They're all smart and hard working enough that any doc could have had any number of good paying jobs during that "lost" wage earning period. They deserve to be paid well when they are done because 25% of that is really nothing more than a form of "make up" pay for lost wages and the interest on those lost wages for all those extra years of training.

Ya see it's not just being left of center, but being pro-labor and an activist for the working man that makes for a well balanced lefty and I'm proud to be such. Doctors are "working" men too and they need to realize that and organize and fight as such. Too many of you folks (mostly specialists now I think) are too arrogent to admit this to yourselves, no less outwardly. Docs need to see themselves as working folks and join up with them and work together for reforms that are good for all, including working docs and other healthcare workers. Get it?

Imagine being a school teacher who can go to work with a BA while earing their masters usually, all while getting paid OK and having full Bennies too. Can't go to night school part-time while still working your day gig for Med School like half the lawyers in NYC did at John Jay College. Think of all those years of good wages the doctors missed out on....

But back to the oath of poverty and the milk. Providers should be paid just as well as a SuperMarket. They charge a real charge based on market factors in their area, get paid the same from any and all comers and whether someone walks in with some form of assistance for the payment of their services, doesn't matter a darn. They charge and get paid exactly the same. Right now, it is the providers who are financing healthcare for the poor by being paid so terribly by the gov't.

The foodstamps really is a better model for paying private service providers for providing care or service for those who need assistance. If we as a society want to provide care for any and all comers, then we need to find the national will to also pay for it. Now I believe that a lot of that funding already exsists, it's just going to greedy Corporate officers and shareholders at UHC and all the other for profit and many not for profit, but not charitable, insurance carriers. We could probably pay for care for almost all our real citizens and provide a decent and level form of pay for our providers if we took that money and applied it to care instead of corporate pay and waste. Those studies have been done already and the numbers are there to support such switching of priorities.

I just went off-roading "wheelin" with my Full Size Jeep club this weekend in southeast PA, near Harrisburg at Rausch creek. The park is land that used to be part of the coal industry. We were just about camping on the remains of coal and my kids looked like two troggladites, I swear. I am still sneezing out coal dust a day later. The stuff is incidious, it gets everywhere. I say this because you can't help but think about the hardworking guys who mine this stuff while being there. Just imagine only 40 years ago while the United Mine Workers were still fighting their battles for standards and saftey what it must have been like living and working in the company town, shopping at the company store and living and working around these places. It's unreal how it just gets into everything. Even those who didn't work in the mines but lived in the area must have gotten health issues from it. No less we still need better standards even today (a moment of silence for our fallen workers). Every years thousands of workers in the US don't come home from work every year; Death on the Job. Your job is literally killing you. Chew on that....I believe it is 100K.

Just about everyone really is in a struggle against these large, multi-national corporations who just don't give two hoots about any of us. Lead in toys made off shore, while loosing good jobs, healthcare dollars wasted on big Pharm and the Carriers, Next Gens, GE's and the like. It's all the same. We need to stand together and demand that these systems serve all of us, both those that use the service and those that provide them. But that means a real change in perspective and reaching out across lines to join forces. Are Doctors really ready to go there yet? I don't know. Dr Neve and the Physician Teamsters are trying here in our town. Can you folks finally accept being part of the AFL-CIO or the Teamsters? What say you folks???

"Well I saw the miner washing, scrubbing coal dust from his back; and heard the baby crying, got no fuel to heat the shack....But the Banks are made of marble, with a guard at every door, and the vaults are stuffed with silver, that the miner sweated for......."

Good Night and Good Luck
Paul

"And Daddy won't you take me back to Muhlenberg County?" "Mr. Peabody's Coal Company done hauled it away." Don't get me started on the raping of the land by the big coal companies. I spent a good part of my summers in high school swimming in the ugly stripper pits left by the coal companies in Southern Indiana and Kentucky. I agree with your assessment, Paul. Just wish we could get what we have earned. Used to be we at least got some respect and appreciation but that too has ceased.

Leslie

Leslie,
And I totally agree with you, that folks like you and the others do deserve to be paid much better and easier too. Every time you guys don't get paid is all part of the "game" of paying for healthcare, by good folks like yourself. Again, it's why I really like this Food Stamps model. It keeps you guys on one side of the street as the private provider of services whose skills and training are of high regard and are worthy of being properly paid for, all the while we as a society, if we so choose can still assist legitimate citizens of our nation with aquiring access to your services.

Just because your services are needed by everyone, doesn't mean they should be suddenly devalued. All the more, if your services are so vital to us as a society that we deem it required for all, then obviously you should have a very high level of respect and be well respected. Part of the lack of respect that doctors suffer from is all part of the disinformation campaign that the carriers and the gov't have been advancing for years. And that the provider organizations have been too blind and nieve to combat against. Now your in a deep hole with time running out and trying to run the "2 minute drill" to get back in the game. I remember just a year or two ago there were articles in major journals, basically saying how messed up things are for docs and patients, but no we shouldn't be and we don't need any unions. Blind, simply blind.

I've got a real suggestion to all you providers. I recently wrote Senator Clinton (my rep here in NYS) and Senator Edwards asking if they will come right out and support a physician's right to organize and join a union. And will they support a change in policy and personel at the FTC to over turn their anti-free trade rulings that have put docs into a corner with no leverage to fight back with. I think that each and every one of you needs to send such letters to every candidate of your choice and get this issue on the map once and for all. Otherwise, they are going to try and reform healthcare without your voices at the bargining table and goodness knows what that is going to look like. You'll all be asked to cough up what little is left of your fees to help pay for healthcare....AGAIN. All while leaving many of those same large carriers and their crooked CEO's unscathed.

Are you really going to trust the AMA to represent you on this one??? AAFP??? Name your specialty. They have done such a "wonderful" job so far. Just how did we get here? Who was asleep at the wheel while Rome burned? Just add another patient per day every time the fee schedules go down again, right? Henry Ford has turned up the assembly line so fast it's just insane, and now they want to hit you guys with P4P? Where was anyone's concerns for performance all these years while they ratched up the speed of the line for goodness sake??? P4P is a perfect example of docs being lead to slaughter under that false notion that somebody at these carriers or Medicare actually cares about patient outcome quality. These types of issues are exactly what unions fight for at the bargining table in other industries. How fast, at what rate, under what conditions, measured by who and how. Work place saftey, job conditions, job related stress, time alotted to get your job done and at what rate of compensation.

Me personally I think the Food Stamps model combined with providers being able to organize and unionize is the only viable solution. The old model has been working so well for you guys up until now, now hasn't it? How else will you guys ever have the leverage to fight back against such a strong and ruthless enemy as these large carriers and the Medical Industrial Complex? I can almost see Ike saying it now..... "beware of the Medical Industrial Complex".

Good Night and Good Luck
Paul

Can you imagine what cries of indecency we would hear if Wal-Baum's had to go through a third party payer to get their payments? Or, what if the gas stations had to wait on average 2-6 weeks before they got paid for the gas someone bought. And, had to bill the buyer on top of that? We, as physicians and as a society in total, have ALLOWED this to happen. We have cut the throats of our neighbors and friends by trying to save a buck or two shopping at humongous discount stores and foreign auto dealerships who basically support only foreign workers. We have desecrated the true Middle Class by electing politicians whose understanding of global/U.S. economics rivals their understanding of neurosurgery. We have literally taken the remains of the disposable income out of the pockets of Americans and put it in the pockets of the Chinese, Koreans, Japanese, etc. with our wide-open door trade policy. We may as well go ahead and concrete all of our farmland because the American Farmer can no longer compete with Brazil and Mexico and China...all because we, the Middle Class, have been squeezed so tightly we cannot help but try to save a nickle here and a dime there. It is a vicious circle in which our leaders have put us. Soon medicine too will be a job Americans will not do. It is already happening. One cannot defer an income for 12-16 years and then hope to make it up and support a family in today's medical environment.

Leslie, who promises to get off this soapbox

Let alone paying support staff and a high overhead while keeping affordable healthcare available in small rural areas! We re-opened this practice after the previous owners decided it was a loosing proposition. The "gang of three" have worked without paid time off, insurance, etc for three years because our pts begged us to stay open. I hate shopping a Walmart, but am forced to by our situation. At 55, there are many things I should be monitoring healthwise but can't afford to without health insurance. Then, we have to listen to pts complaints about their high copays and deductibles! Thank God we have a sample closet so I can at least keep my HTN under some control. And I'm just the office manager! Something's got to be done about insurance and drug monopolies and their grip on the healthcare system (and I use that term loosely). My Dad was born in Canada, I'm thinking I could be naturalized up there...

"Right now, it is the providers who are financing healthcare for the poor by being paid so terribly by the gov't."

Paul, this is something I have said over and over. In our state at least, Medicaid gets funded mostly by cutting physician and hospital reimbursements. It's outrageous. To charge a certain fee and be reimbursed that entire amuont by self pay patients, almost that amount by private insurers, and about 2/5 that amount by Medicaid is unbeleivable. The problem is NO ONE knows about it. There are a few times where the topic comes up when I am seeing a Mainecare patient, and they are LITERALLY shocked! They had no idea. I am willing to be the assistant to the attorney general in charge of antitrust law has no idea how it works.

I always think all the doctors should get together, but I am not sure how, and then I think of the AMA, AAFP, AAP and the Maine Medical Association and wonder why they haven't helped us to unionize. My attorney told me he wonders all the time why the hell doctors have stood for what we have stood for or not stood for. Sure, if we banded together, it would be antitrust, but who cares. If every FP and Pediatrician stopped seeing Medicaid patients, it wouldn't take more than a week before the healthcare system collapsed.

In January, I couldn't afford health insurance, and I ended up in our local hospital for 2 1/2 days. $6,000. I pay $100 a month. This will take five years to pay off.

In most other industries, the amount of pay is figured out by collective bargaining. I have no idea why don't have the same. The government already oversees Medicaid and Medicare so what is going to happen with their is universal healthcare?

The system is really screwed up when one comes out of medical school with a loan burden of $160,000 then goes to residency for $28,000 while half of those loans compound interest. I have been paying on mine for ten years now and I doubt I have even made a dent. The least the government loans could not charge interest or at least lower it.

And, then the thing that completely burns me up. A tax law is passed, what, five years ago making student loads deductable. But, only for those making under something like $40,000. I have no idea why we should be punished for making more money. We make more money, because we went to medical school and acquired more debt. It makes no sense.

It also makes no sense to me that certain types of doctors make more money than others. I have no issue with a physician who did a three-year fellowship having a higher base pay, but why should psychiatrists, family practitioners and pediatricians be the lowest paid providers? Do we work a lot less? Do we have less stress? Are our services not needed as much as anesthesiologists or radiologists?

I just don't get it.

Get this...I have been prescribing the heck out of the Zostavax. I do not stock it here in the office (can't afford the upfront cash lay out. In fact I stock no vaccines any more)So I write a script and send people to a local pharmacy that stocks it. They pick it up, bring it back here and I administer it. Only about 20% of the patients' insurances are paying anything at all for it...guess which one pays it all?? Indiana Medicaid!! Same thing for Chantix. I am sorry but this is just not fair. I had a MEdicaid patient ask me to write a script for an elastic ankle brace because shehas trouble wrapping an ACE. I told her she didn't need a script and she said "Oh but Medicaid will pay for it if I have a script". I refused, she got P.O.'d and I really don't care. My one employee with MS (full time, here every day, excellent worker) had to drop her insurance when it got too high for her to afford her contribution. How did we get to this point? Who let us down? How can we right things? Wish I knew. I guess the saying is right...the weak/poor shall inherit the Earth. They are the only one that will be able afford to pay the inheritance taxes.

Leslie, who broke her promise to get off the soapbox

Thanks to everyone who has been venting...I thought I was the only one with these thoughts....


Barbara

Barbara,

No, we not only think them; we think them everyday.

Leslie, you should have prescribed Tylenol for her. Not sure about Indiana, but damned near everything OTC in Maine is covered by Mainecare. Thanks God, they pay for the three days of ear pain at 2PM in the emergency room, because God knows I couldn't have 1) treated them more quickly, 2) less expensively, and 3) maybe even better. No probably wrong on number 3, I doubt I know anything about the dosing of amoxicillin is a 15-month-old daycare patient or what oral medications to use for MRSA.