Yep. In fact the door into my office is only 4 feet high so people will have to kneel before me.

Actually, if people would stop pay for the high priced medical equipment, medicines and go back to the old ways. The monsters who make billion ripping off the little guy would have to lower their prices.

Until the previous two years I worked in health care administration and insurance. I have worked both sides, managing A/R departments for large physician practices and small ones, and also being an adjustor for CIGNA. "Maximizing" reimbursements from third party payors (insurances) was my trade when I worked for the physicians, and I was good at it. But my conscience got the best of me and after years of dissatisfaction and burnout I finally left the profession. I miss the money but not the stress. And I know it's because of medicine's business model that a whole industry of medical billing has arisen. I don't really blame the doctors too much. For one practice (OB) our malpractice costs increased over $1,000,000 in a year. No suits or anything filed. Just an increase... In addition, there are so many clerical and ancillary employees to pay that the practice must generate enough income to cover it. And that's not to mention the provider's own salary needs, as SPG has already spoken of. There was always the pressure from administration above me to find ways to increase revenue. I have even had instances where I was asked to use "creative coding" practices (read illegal) to generate income.

When I worked for CIGNA, I never had anything of the sort. There were clear rules. We followed them. We made mistakes sometimes, but we could correct them. I never was asked to make a decision that I thought was legally questionable. Just the opposite.

I hate insurance companies, too. I wish medicine would back away from the form it currently exists in. However, some party in the triangle is going to have to give first. It likely won't be the doctors who will voluntarily lower prices, and it definitely won't be the insurance company who begins to practice responsible profit taking or even more equitable RVU assignments or valuations. And the patients will always take the "best" (read most extensive) care they can for their insurance dollar instead making choices with those healthcare dollars as if they were coming from their own pockets. But it'll likely be the patient who gets the raw end of this deal again.

No matter what happens, universal healthcare or not, the transition is going to be bad. Doctors in the last practice I worked for have opened a "boutique" clinic of sorts. A separate building for cash only patients. Much nicer decorations. Caters to women wanting hair removal and laser wrinkle fixes. Also does cosmetic tatooing. Treats minor ailments for cash payors. This clinic operates on a part-time (few days a week now) basis for the time being. But it is very new. Most of their patients are self-employed people... Minimal staff is required, even with the fine office appointments they charge the cash payments way less than they charge the insurance patients in the other office.

I just got home from the rural office I go to twice a month that is an hour away from us. Husband pointed out this thread to me, and I HAD to post!

In the fall of 2006, I went into private practice. No fancy digs ... simple office space with just me, a part-time receptionist, husband who helped out a lot (although he was telecommuting to his own job from our office there at the same time, so he was somewhat divided in his attentions), and our teen-aged son who did filing and the like after school (or homework) until we drove back out to the farm from town. Didn't even have a nurse.

It was a FREAKING NIGHTMARE! Most weeks we were there 6-7 days, although I didn't see patients on weekends. It was the totally screwed up Medicare/Medicaid paperwork snarls that we kept trying to unsnarl.

I still have about $10K in outstanding receivables that Medicare and Medicaid never paid me. I am sure I will never get that money. We could never get a real person on the phone to tell us what the problem was ... we did get a lot of snail mail from them. None of it made sense.

The whole experience almost bankrupted us, & put us into a rather unpleasant relationship with the IRS.

When people hear that I practice medicine, they think we are rich. HAH!!!!!!

What I do is still a calling -- truly -- for me. But it is a huge burden as well. In lots of ways. And the system continues to want more and better for less -- less time, less money -- more paperwork.

Sucks. Big time.

Thanks for listening.

Lumpy

Yeah. I love seeing cash only patients. Saves me mountains of paperwork. In our office, cash patients get a 20% discount. I'm definitely not running a boutique practice. Much more along the lines of trying to cobble together health care for people with no insurance and no money. I'm pretty serious about providing healthcare in a way that uses less resources. I frequently have long discussions with patients about why I want to give them a prescription for the $10 drug instead of giving them samples of the $60 drug. There are a lot of insurance and medicaid patients that get really offended by the idea of getting less expensive medicine. If the other one costs more it must be better right?

Couldn't hurt to grow some aloe vera on your porch. That stuff is amazing for skin ailments. Been used for that since antiquity, for good reason. You can get it at a nursery.

Lumpy,

If your claims aren't past timely filing limits I might be able to help you get that money... I can usually audit the claim data with the notes and RA and figure out what it needs to get it through the system. I am not saying you don't know what you're doing or intend to insult your ability. Just to offer some assistance.

Anyway, you can pm me if you are interested and haven't just chalked it up.

I feel for you.

I just had a conversation with Medicare this afternoon. My receptionist has taken over a lot of the billing stuff (Thank god!). She mentioned that we several outstanding medicare claims. I said "Ok...I'll call them." Then she hands me this list of like 150 claims dating back several months. So I finally got to speak to someone about it today after two days of phone tag. Turns out what happened was that Medicare somehow transposed two digits in my address. The post-office returned something they'd mailed, and so Medicare put a hold on my account.

It wasn't so bad getting myself signed up initially, but getting my PA signed up was an absolute nitemare. All the rules are different for PA's and most of the low level people reviewing the applications don't know the rules. It took over a year, at least 40 hours on the phone, and a stack of 8.5x11 forms 3 inches thick to finally get her signed up with Medicare.

I've been playing doctor for a couple of decades and let me tell you, it aint got me noplace. I dont even get those tax credits and medicare payment the fed puts out. If things dont change, and I mean soon, I'm out of here!

That survey would certainly explain this.



If the primary care situation is bad now, wait a few years when we'll have even less doctors as many retire and few take their place. Both of my roommates are 2nd year med students. One of them had contemplated dropping out because when he talks to doctors, he says they are all just miserable about their jobs. He's sticking with it but it's certainly better than his other prospective career: real estate. He sure knows how to pick 'em.

So for you physicians, how much would electronic filing help out, as it is one of Obama's ideas for reducing time with paperwork and so forth? Would it actually help out or is it much like putting a band-aid on a bullet wound?

Wel, let me help
MOST ilnesses are caused by peoples bad lifestyle.

Soon there WIL BE NO PHYCISIANS that will want to see you, and the ones you will see wil be PA's who havnt' a clue (who take full price pay from medicare all 15 dolars out of 100 worth)

Everyone will be given amoxilcilin and cough medicine and told to go to the ER if not better.

Those who go to ER will be sent back to the clinic.

Look, You have to get back to simple basic food two meals a day at about 1000 calories a day. This will get you healthy. Boil your water and drink a liter a day, exercise and loose weight if you are heavy.

If you smoke, stop
if you drink stop
give up al junk food and caffien

and buy aspirin and motrin and tylenol

If you have bad genes, and you have multiple illnesses, you just aren't going to make it through this.
Sorry, get your house in order.

I was referring to the "need" for monthly check-ups to get a new prescription for a drug that treats a stable, chronic condition.

If Lescol (and drugs like it) were available for purchase in 3 month or 6 month batches, consumers would be able to save a tremendous amount of time and doctors wouldn't be swamped.

Another example, antidepressants. Once a patient stabilizes at a given dose, couldn't they just be given a 6 month supply?

Moreover, I think lower level medical professionals could probably handle prescription re-writing for people who have already seen their doctor to get the medication in the first place.

I'm just trying to reduce the burden on primary care professionals. Maybe I don't understand enough about the situation (I'm taking a class called Health Care In America next semester so that might rectify the situation )

Forcing electronic claims would be akin to curing your bullet wound by hitting yourself in the head with an axe. The payers prefer electronic claims because it saves them money. The problem is that as soon as you start filing electronic claims, you become subject to HIPPA(i.e. a couple hundred pages of cumbersome, intrusive, pointless, and expensive government regulations). The other problem is that every payer ends up using a different format for the electronic information so formatting the information to fit their system is a total PITA and if you make a trivial formatting error they reject your claim.

No.

Look, medicine is all about "THERE MUST BE A DOCTOR TO SUE"
Everywhere, from ambulance pickup, to medical control to er visit to admission to discharge, there has to be a PHYSICIAN OF RECORD so they can properly be sued...

this is a fact. Someone HAS to be in charge to be sued.
Now, no doctor in his right mind will give someone a 6 month supply of antidepressant, have the guy kill himself and the family will say "WHAT A SHMUCK HE JUST SHOVED PILLS IN HIS FACE AND HE LIKE HAD NO ONE TO TALK TO SO HE KILLED HIMSELF."


This is normal. This is what people do. This is what their LAWYERS TELL THEM TO DO! How many times does a guy come in with a stiff neck after a car acciedent two days ago and say I WAS IN AN ACCIDENT TWO DAYS AGO and I was ok but my Lawyer told me to get checked out. TOLD to.

and stories change.

A mother called in to an Emergency room and just asked "What dose of tylenol do I need to give my child?" Nurse asks, How much does your child weigh?" She says 20 pounds, and the Nurse tells her the dose and says we would be happy to see him if she would like, mother says NO, I will try the tylenol.

three days later baby admitted for meningitis and dies on day four.

Lawsuit comes in 6 months claiming the NURSE TOLD HER TO STAY HOME AND TAKE TYLENOL.

THEY LIE, bro, they lie all the time when someone dies.
so no, you won't get pills without someone to sue, thank your attorny for that.

also the liver pills, so he gets toxic and develops stevens johnson and dies, the family goes LOOK HE DIED! SUE THAT GUY!

right?
yes it is one in a thousand but that is one doctor with no more malpractice MEANING NO MORE JOB.

so, NO, because of LAWYERS we have the WORST health care system in the world.
Go to the ER and just SAY you are dizzy and you will get a CAT skan and an 8000 dollar charge just so they wont sue you.
it suks''and when you get GOVERNMENT HEALTH CARE which doesnt ALLOW you to get CAT scans or do liver tests and WHEN someone dies and you DO get sued, (cant even order a ton of tests to defend yourslefs) the doctors will drop like flies...
and again...

HERE IS THE 2x4 of truth
YOU
WILL
NOT
HAVE
ANY
MORE
DOCTORS
BECAUSE
of the
DAM LAWYERS

bottom line.

But of course, you TOLERATED them and LIKED them while they won your cases, now you can let them treat you.
LOL. This is going to be sweet.
The only people that wil get decent health care will be the retired doctors families... At least there is a benefit.

Did you hear about the trial lawyer who had a malignant astorcytoma of the brain (brain tumor) and not a neurosurgeon in Florida would operate on him?

True story.

Finally justice was done there.