Home Forums Discussions General Discussion Who Speaks for PCP's and Their Patients???

Leslie,
good news, you don't have to fill out all 88 pages. only fill out the change of adress section and also the EFT deposit section again even thogh that isn't changed. Trust me, you will save yourself some headaches.

I think Belkis is right. I keep forgetting to ask my biller.

BC

Awwwww, I loved the jackass pics. By the way, a mule is a cross b/t a horse and donkey right? Whats a jackass?

I'm a surgeon using AC for over a year now, and the problem with reimbursement is not just for the PCPs. It's across the board really. Ask your friendly CV surgeon what the medicare rate is for a CABG and I think you'll be shocked considering that this is global fee for 90days post op. The only specialties being paid well seems to be anesthesia and radiology just because their volume is so high. The rest uf us who have to TALK to and examine patients simply can't cut back any more timewise to increase out volume. All of us are pretty frazzled with trying to give the best care, but see as many patients per day as we can just to pay the bills and justify the malpractice costs.

Patients really do think we are all rich. I had one recently write me a letter and complain to the referring PCP that I actually charged her credit card for a balance owed!! In the letter, she said that my financial status was obviously better thatn hers and I should let her pay out over several months with no interest. I mean, what do I look like? A friggin bank? I have overhead, salaries and expensive supplies to buy. Not to mention malpactice ins, liability ins, disability ins, offece overhead ins, life ins. None of these companies are letting me pay out with no interest.

Sorry for ranting, Bottom Line: All physicians need to get politically active in whatever society you want. Insurance payors have more money and fund the lobbyists and that is how the system works.

jack·[censored]
Pronunciation: 'jak-"as
Function: noun
1 : DONKEY; especially : a male donkey
2 : me, at times.

Those are some great-looking donkeys.

I just got two little female donkeys last week, Lucy & Ethel. They are about nine months old, and adorable. They have not been handled much and won't come near me yet, but they eat the apple pieces I pitch, when I'm not looking. I would post pics, if i knew how!

Brian Cotner, M.D.

OK, the censorware blocked jack [censored], not me.

Paul's [censored] and bull story was similarly censored recently.

If we can't talk about our [censored] es or our [censored] s, how can we discuss our farming dilemmas?

Farmer Brian, M.D.

Just got my son's dentist bill for 2 cavities yesterday. $511.00
I'm having it laminated for the front desk staff to use. Who would think we'd get to the place where one cavity is more valuable than a head-to-toe physical, treating congestive heart failure, diabetic neuropathy, etc. etc. etc.

What are we doing wrong?
What are they doing right?

Dave:

I'll take a shot at that one.

My wife is a dentist, retired now, but this was true a few years ago:

1. In general, dentists DO NOT FILE INSURANCE. They make the patient file (although they may assist). That puts the monkey on the patient's back -- if the form is confusing or they get an unfair denial, *they* call their own insurance company and hassle them about it. Doesn't that sound nice?

2. Dentists have held the line against HMOs and PPOs. They do not let any third-party payors set their prices. I can't tell you how they managed to stick together when physicians didn't.

And so you see, the answer to all our problems is simple. All the doctors just need to get together and post signs saying:

"We no longer accept insurance. File your own, if you can."

Brian

We physicians are trained by large entities that really don't have any vested interested in the physician's financial welfare. Does a University Professor in Medicine really know the financial realities of running a business? Does a residency director necessarily have training in running and marketing a business?

The dentists, to their credit, are mostly independent. They are smart not to sign on to government programs. They help each other out rather than come up with ideas to hang themselves.

I'm looking through resolutions going through the WSMA House of Delegates for this year. I see numerous resolutions sponsored by academicians proposing more nooses for us to hang ourselves. Last year, at the House of Delegates, there was a proposal to have special reporting requirements for physicians in trouble with the law (kind of like registering as a sex offender for traffic violations). I added a friendly admendment that we should be made to wear black armbands with yellow Cadusas along with a plainly visible 1-(800) XXX-XXXX number of the Medical Board. This way, others can report us to the Medical Board and would save ourselves from self-registration for an assortment of legal issues. No one supported my amendment, and the entire resolution went down in flames.

We blame lawyers for making our lives miserable. However, there are just too many "Do-Gooder" physicians pushing for requirements and regulations to help doom ourselves.

We, as a profession, is in a deep deep hole and we need to dig ourselves out. We need some of you hardworking soloists to become delegates to your medical societies. I am a delegate (although it represents loss of income and inconvenience for my clinic) because one voice of reason can change the course of a discussion. I have help shoot down really bad ideas that will only hurt our profession. I have made resolutions to improve reimbursement and help level the playing field between physicians, hospitals, insurance companies, and government. We need to fight P4P, CCHIT, EBM, and an assortment of well intended (but ill conceived ideas) before it becomes a new set of regulations to make our lives worse.

Enough said.

Ah, the grass is ALWAYS greener.. Guess what I did for a living for almost 25 years before going to medical school? And my rates were a lot higher than $95/hr - even in the 1980's

Never give up! Never Surrender!

V.

Dr. P,

Isn't it ironic that if you raise your rates, Medicaid, Medicare and Private won't pay them, AND if you lower them, you get into trouble as well?

Vinny,
No offense. But you are either glutten for punishment or privately wealthy. Why the heck did you become a PCP, FP? I gather some of it had to do with other issues in the business world, but still... You must be one very generous soul to give up such a living to suffer thru Med School and Residency for all "this". Shame someone like you won't reap the financial rewards that your good nature deserves. And all our friends for that matter.

Dr W,
At least you folks although your rates are stagnant, you have nice procedures to do and surguries that at least allow you to still make some amount of a living. I know your cost like ours are going up thru the roof and your malpractice must be unreal, but in primary care, all we do all day is level 3 and 4 office visits. And most of the carriers and the specialists make a joke of the relative value units by getting contracts and fee schedules that pay let's say 120% of Medicare for E&M's but 140% for procedures. So we on the primary side get it much harder while even some of our very own peers are contributing to this inequality. Try to imagine if all you did all day was level 3 and 4 office visits and lots of unpaid busy work for patients, carriers and specialists who all want what they want. Those of us on the primary side are at a breaking point. Now I don't mean to pick on you or to make an enemy of a commrade in arms, but we on our side of the street need the support of our brothers and sisters on yours. Feel like supporting the fees schedules that pay equally or better for E&M's as compared to procedural codes for starters? Fees that are 20% higher on all codes only for PCP's so our office visits may finally pay the rent? Even our own IPO's do these things and condon them. Sorry if I ruffled your feathers, but living on 40-60 bucks a visit kind of gets old very fast. It just feels like even folks like the AMA or docs in other specialties don't really give a hoot about primaries. Sorry for spouting off....

And to all of you: I promise to never give up and never give in. That is why I sign my provocative posts with "Good Night and Good Luck". Keep the faith y'all and have a great weekend....

Paul

I have to come up with one conspiracy theory each month.

I believe there are physicians in primary care who want to keep reimbursement rates as low as possible for their own greed.

In the past when there was a resolution to raise Medicaid rates to sustainable levels, there are always some physicians who objects.

The argument goes like this (I need background violin music): "There just isn't enough funds to go around. By raising Medicaid rates, it would hurt access to care by limiting the number of people qualifying for the Medicaid program. It would be wrong to hurt our most vulnerable populations, the children and pregnant mothers."

Believe it or not, this argument works!

I suspect that the people who say things like this are those who are benefiting from FQHC where they are given grants and reimbursed at much higher rates for seeing Medicaid patients that have limited access to care (because of the low reimbursement rates).

What do you think?