Posted on 03/23/2006 3:47:56 PM PST by neverdem
That's why all the ER docs here at the big hospital are salary employees, rather than private practice. It was killing them.
Talk about the rock and the hard place.....
Not all your comments are accurate.
"The health care system in this country has gone down hill for years, starting with the horrific HMO type insurance."
Yes, this is true. Ever since the introduction of Medicare in the 1960s, the government has mismanaged the program. Many HMOs, especially community based HMOs, are in effect hired contractors to the government to manage doctors and their Medicare coding. HMOs are 'middlemen' in the business that take revenues off the top of doctors for themselves and at the same time perform contractual adjustments in negotiating reimbursement rates from the government. They save the government money and make themselves rich. Doctors and their staff get screwed.
Because of poor reimbursement rates, clinic budgets are stressed. RNs are replaced with MAs who hold a six month degree. Experienced docs are replaced by young docs who are glad to be making something better than resident pay that they had for the last 4-6 years and they have monster medical school loans to be repaid.
HMOs tell the docs to see more patients. Every year more patients must be seen to offset cuts in reimbursement rates and to support HMO administrative staff. More patients each day translates to less time for each patient.
Lots of docs are fed up, especially the experienced ones. They are going back to private practice and some are attempting to charge fee for services or negotiate their own plans with patients. Each step of the way they are impeded by government regulation and legalities. HMOs try to stop docs from going to private practice by blocking hospital priviledges or acting as credentialing certifiers. They know that docs going to private practice means less revenue for them, and less acceptance of medicare and medicaid patients because of poor and declining reimbursement rates. There are many procedures that are so poorly reimbursed that the docs lose money by seeing these patients.
"The doctor gets paid not to see you, not to send you to a specialist, and not to send you for tests."
Not exactly. For standard insurance plans or fee paying patients, docs obviously do get paid to see the patient. For Medicare and Medicaid, docs and their staffs are often not paid or are very poorly paid so they try to close their practice to new Medicare ot Medicaid patients.
However, for an existing patient in a doc's practice, they must by law see the patient, whether reimbursed or not. And they must by law refer a patient to a specialist when there is even a slight possibility of missed or delayed diagnosis or treatment. To not do these things increases the risk of malpractice liability exposure.
So docs do not get paid to NOT see a patient. They just refuse new patients to stop the cash bleed from patients that have no insurance or poorly reimbursed insurance. Most docs do accept some charity cases, about 10% as an unwritten rule. But they don't advertise it because they would be bankrupt in no time with so many patients expecting free healthcare.
Oh, I didn't think you were lumping me, or all docs into any group. Just giving a perspective from an MD's side.
Oh, and I can also tell you I've seen docs cancel appointments and run hours behind/late for very selfish reasons. So in many cases, you'd be justifiably ticked!
While I don't think it was snowing, my doctor came out to the house for a mere follow up. Said he was in the neighborhood anyway. Course that was the same doctor that had delivered me 5 or 6 years early, which means it would have been '55 or '56.
You've actually put your finger on the cause of the troubles. The patient, and the customer not being one and the same. Since the patient can't decide how important a particular procedure is to him, (having paid his money, one way or another, long before) he can't say, well, it's expensive, but I need it, or want it. Or alternatively he can't say, it's expensive, I'll see if I can find another doctor who can do it for less, or I'll wait until I really need it. Whatever "it" might be. I know I haven't said that very well, but I think the basic picture is clear. Everyone has "customer" they need to satisfy, doctors are no different really, things work best when the customer is also the one that benefits from the work.
I've noticed that an awful lot of the Drug company sales reps are hot babes. Maybe it would be best to get a lady doctor, or one too old to really care. Nah, that old would be too old indeed, he might not even have a pulse. :)
Man, that's one heck of a gestation period. Kudo's to your mom! :-)
Even with "other types of insurance", the doctors may not be getting paid as much as you might think they are. They often have to have contracts with the insurance companies that say they will take a much lessor amount than your bill shows, or that you would pay if you came in with checkbook or cash in hand. So even if they discount for cash, as the clinic where my doctor works (yes, he 's just another employee), does, you still might be paying the doctor more than the insurance company (plus your co-pay/share) would have.
Many insurance companies, mine for example, are very slow payers. I'd get a different one, but it's the only one my company offers for "off-site" employees.
My allergist, who was our pediatrician before she went back to school for a couple of years, and whose husband (well now ex) is a general surgeon, told me 10 years ago that she was telling her daughters not to go to medical school. Too much of a pain in the rear. They were hardly fresh out of residency, and there two doctors. Yet I know where they lived, not far from my humble tract house abode, and it wasn't a mansion or anything. Those seem to be reserved for the money men, insurance company execs, the CEOs of medium to large companies, along with professional athletes and other entertainment figures, and of course politicians.
My internist is a great doctor and really explains things well. My only problem is that she is affiliated with a large city hospital that is about 30 miles from me. There is another large hospital about 15 miles closer and more convenient for me. I have seen doctors at both hospitals. I recently asked my doctor if I should try to use doctors that practice at the same hospital in case I have to be admitted. She said it didn't really matter. She wouldn't be seeing me if I was admitted anyway, a Hospitalist would be my physician while I was hospitalized. I had never even heard of a Hospitalist before. What do you think of this practice and are most hospitals doing this?
$54 for seven minutes per person for a GP.
Ironically, the NY Times promotes the kind of fixed capitation, heavily managed, low fee, government controlled medicine that creates and sustains the 7 min. appointment. If the gov. gets their hands on it, you can count on even shorter appts., if you can ever get one.
But, hey, its ok, cause everyone will "have access" to this great care. /sar
Yes I did and I enjoyed telling him how at 1st he had been so caring, (when the practice was 1st starting up) and how nasty over the years his staff had become. The nice ladies left to become replaced by his family members. When my daughter's new DR called for her records they wouldnt fax them though I had signed a release. They want $40 dollars for each family member's records. That shocked me. So I said I would pick them up, still $40 per person. I am very amazed that I have to pay that much.
Reading this thread, I remember exactly why I closed my office and went to work part time and back to school for a Bioethics Masters. I was already trying to change the system, and knew I needed more initials to get attention. But I got burned out and fed up with
1. The assumption that I was only in it for the money. After all, I just looked at them and wrote a prescription, right?
2. The assumption that I was committing "fraudandabuse" - guilty until proven innocent - with Federal felonies and audits I would have to pay for if ever I got above the radar. That's without even considering that I was hearing about armed raids on hospital records departments and docs being harassed for refusing to allow government officials to video tape and copy records -
3. Trying to learn and follow E&M codes, ICD-9/10 codes, and the latest documentation requirements for each.
4. The government mandates for technology and "certificates" in order to practice medicine (look under the microscope, dip a urinalysis, run a flu test that medicare wouldn't pay for anyway).
5. The "patient satisfaction surveys" and the insurance company black box quality assurance reports (I don't know what they're measuring and half the patient names on their lists were either on-call patients or people I hadn't seen in years) and the bundling of charges.
6. Stable or decreasing fees, while my own health insurance, malpractice fees, licensing and certification fees, rent, utilities and all the other overhead went up.
7. Employees who would quit for a new job paying $3 an hour without health insurance, when I had been - in effect - taking money from my take home pay to make sure they had insurance.
8. Hearing about Dr. Chiropractor, Dr. Nurse practitioner, the school medical clinic nurse practitioner and the ER doc from Saturday morning and what a great or what a bad job they were doing. (They might have been great people and practitioners, but the care was not appropriate for that particular patient who needed a primary care physician for their medical care. )
9. The way my professional organizations were practicing social eugenics with my dues and in my name.
10. Frank embarassment about what some of my professional colleagues were doing - refusing to see Medicaid patients they were assigned on call from the hospital, lack of follow up and more and more money making procedures (admittedly due to third party pressure) with less and less patient care. The games with consults vs. E&M, insisting that the FP admit and do the non-paying scut work, but the consultant gets paid for high-dollar procedures, hearing that "you need to follow-up with your Primary Care Provider" on discharge, and the docs "supervising" clinics with unsupervised NP and PA's, Medicaid patients whose official PCP - printed on their card, for pity's sake, is one of those clinics, not even one of those "Providers."
I only wish my family's doctors would view us as customers. I have no patience for the endless hours of waiting. For myself, I'd rather endure many discomforts and sicknesses.
I went for a annual gyno check up that was no more than ten. I knew this was so because I was timing her. I almost afraid to find out how long her pap smear would be (((shudder))).
Seven minutes with the "GP," plus all the office expenses. Look around, what is in the office that's free to the "GP"?
ping
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