The Sad Case of the Patient Protection and Affordable Care Act

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

All of Europe. I'll take your eye teeth next week.

All of Europe what? Don't call yourself a dentist yet. If I had a choice to practice here or in Europe I would go there in a minute. At least my patients could get rudimentary coverage and the option to get supplemental insurance if they are well off enough. Here I get to spend my time trying to figure out how to help people get the most basic care for chronic diseases, have patients who just don't come because they can't afford it, don't take meds because they can't afford them and listen to well meaning but ignorant people slam the initiatives that would help fix the system while claiming people on assistance are all slugs and should pull up their bootstraps. I also get to be continually baffled by the fact that people do not see that pretending our system is really OK is costing us enough money to care for the country 3 times over.

If I had a choice to be a patient, the US would not be close to my first choice unless I was very well off or lived near somewhere like the Mayo (with those awful 'death panels' and patient care panels). Most of the local hospitals are seriously understaffed, the insurance companies arbitrarily decide what to cover or not, if you are a patient you need to be very knowledgeable or have a lot of luck to get stuff done right during anything but a simple admission. If you are in a 3rd world counrty they tell you you need your family to help you or you pay extra. Here they don't make allowances for your family to live in (in most places) but don't have the staff to watch over everything like they used to.

Capitalism and free enterprise is not a good working model for healthcare. When the bottom line is profitability v outcome not everyone choses the moral/ethical choice. Insurance companies are constantly pitting hospitals/ practices against each other, practices and hospitals are in competition with each other. In our area the hospital is trying to take over all the private practices. Mine is a hold out. They are doing everything to make it difficult enough that my boss will pack it in. Where is the motivation to work as a cohesive system? Since the goal is to be the last one standing there is no motivation for them to work to make things smoother.

Bottom line- the patient is lost in the shuffle but the $ report gets to look like something positive happened.

Meeting with someone this AM in the grand plan to get out. Hopefully it is the beginning of the answer.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Dying. It solves a lot of problems.

There are three choices:

1) People start dying before 70 again.

2) People start living in multi-generation families again.

3) People accept that a very expensive retirement/health care system is the price we pay to avoid 1) and 2).

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

So the solution is?????

Dying. It solves a lot of problems.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I am so tired of hearing how the gov't would take us over and make things more confusing. I would give my eye teeth to have a finite set of evidence based regulations and see the insurance companies reined in.

All of Europe. I'll take your eye teeth next week.

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

So the solution is?????

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Les

Agree with a lot of your points -- but who is setting up all the rules that the insurance companies have to comply with? Or, are they doing that themselves?

In the federal government, we used to have lots of secretaries who did typing, filing, travel, and other admin BS so that we could do more. Then came computers and people started to do stuff for themselves (*I* can do it better!!!!). All of a sudden, less secretaries and VOILA! we're doing it. Less time for doing what we're getting paid for, and more time for the admin BS. Heck we had GS-15 or supergrade scientists trying to do their own foreign travel and then complete the vouchers. Took hours away from the bench.

I hated filing, I hated paperwork. Fortunately one of my subordinates did and she kept me organized.

The insurance companies make the rules under the guise of trying to promote better healthcare. The real deal is they change rules frequently, they do things that are not evidence based and they all have different rules. Rules also vary dependent on the particular plan the person has with in the insurance co. All this changing allows them to dock payments because of 'noncompliance' and then they keep the cash for months while you justify why you should get it. The thing people should never forget is the insurance companies are NOT motivated by what is best for the patient. They are motivated by what gives them the most money, allows them not to pay for things to keep the most money. There is absolutely no motivation for them to streamline things or make things clear/predictable. The more confusing things are the longer they keep money. The parts of the Bill that were to correct this were gutted because we should not impede the insurance companies' ability to do business.

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Les

Agree with a lot of your points -- but who is setting up all the rules that the insurance companies have to comply with? Or, are they doing that themselves?

In the federal government, we used to have lots of secretaries who did typing, filing, travel, and other admin BS so that we could do more. Then came computers and people started to do stuff for themselves (*I* can do it better!!!!). All of a sudden, less secretaries and VOILA! we're doing it. Less time for doing what we're getting paid for, and more time for the admin BS. Heck we had GS-15 or supergrade scientists trying to do their own foreign travel and then complete the vouchers. Took hours away from the bench.

I hated filing, I hated paperwork. Fortunately one of my subordinates did and she kept me organized.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

As an engineer for a medical device company, I see the exact opposite. We are having to do our own admin work which leaves less time for actual engineering that costs both us and our customers and the consumers money. So this is a big problem.

*yes I'm typing this while at work putting off doing some of my admin stuff. No engineering for me today.

Couldn't have anything to do with all the regulations and admin work required by the gov't

You could probably put a nearly identical graph over education

I am so tired of hearing how the gov't would take us over and make things more confusing. I would give my eye teeth to have a finite set of evidence based regulations and see the insurance companies reined in.

I am actively looking to leave Primary care after 25 yrs as an NP and another couple as an RN. Until the last few yrs I had planned to work past retirement age. Now I am getting out of practice as soon as I can find a way to make enough to survive. The govt regs aren't driving me out, the insurance companies are. Due to the insurance companies I can no longer take care of the patient, do what is appropriate for them and know I am going to be reimbursed. I now need to figure out which insurance company is covering the patient, order which ever test that insurance company requires for that age group or diagnosis (no matter how inappropriate), figure out how to code for that particular insurance, chase the patient to get them to comply. If the code is wrong, the patient declines the test (even in writing) or is covered by another insurance so 1st insurance isn't billed they withhold a chunk of reimbursment. Most practices that are larger than 1-2 providers now have a dedicated person who spends 40 hrs or more a week proving that things have been done so they can get full reimbursment. The insurance companies are also forcing the use of EMR(electronic medical records) or you can lose up to 20%. Productivity is down significantly. I spend 6 hrs in pt care and close to that to document it. It used to take me no more than 1 hr on a very complex day. If I worked in a specialty then maybe I would be compensated enought to make it worth it (doubtful) but primary care is getting slammed by more and more requirements from insurance companies and less and less reimbursement.

Contrary to what a lot of the politicos want to tell me I would rather take care of Medicare or Medicaid pts. Reimbursement stinks but I have one set of predictable regs (which altho do not take care of everything at least make sense as far as what they exclude). The biggest headache before was getting dinged for patients not having their yrly PE (which they had to pay for and couldn't afford). Now the new Bill has gone through physicals, preventative care is covered and I have a clear idea of what coverage they have I would rather see them all day.

No matter who gets elected it won't get fixed. Practicing is just not worth it anymore.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

No, the fact that there has been an explosion in admin positions in industries that gov't has a major influence in. Still trying to figure out how you manage to put the talking point of Trickle Down Economics on that one. Not to mention how you contradict yourself by saying that both additional admin and lack of admin are trickle down.

Explosion in admin positions? So that's why they were one of the first targets in recent layoffs in that industry?

[dxmnkd316]

Re: The Sad Case of the Patient Protection and Affordable Care Act

On a good week, I get to spend about 4 hours (10%) on engineering.

"We'll give all the engineers MS Office," they said. "They'll be able to keep their own schedules, draft their own memos, create their own presentations, and author their own documents," they said. "We'll save so much money by eliminating secretaries," they said. Well, now they have a a workforce of overpaid secretaries with 4-year engineering degrees shuffling @$%@ paper around all day. Good thinking.

I wouldn't have it any other way. I do all of my own e-mails, presentations,etc. It would take just as long for me to explain everything than it would for me to do it and get it right on the first pass. And keeping schedules? Cripes, Outlook and Lotus Notes do that for you...

In fact, I'd guess that 80% of my e-mails are technical e-mails and require me to write them (unless I dictated them, but any engineer under 30 years old that's worth his salt should be able to type at a clip that doesn't slow him down). I'm far quicker at typing than just about anyone in our office. Secretaries included. I can't imagine what you're doing that would even allow a secretary to write your documents. Honestly.

Of course, there's the project manager aspects of my job that are less technical, but I wouldn't allow anyone else to dictate things like project schedules, submitting purchase orders, etc. WHile this takes up 25-30% of my time, I would spend just as much time explaining things to someone else and correcting their errors. Especially since most of my projects are relatively complicated and require knowledge of all aspects of the project. Including technical.

I still manage to get in about 70% engineering time when it's all said and done.

For our non-project engineers/managers, we have subject matter experts that don't have to deal with project schedule beyond what the project engineer takes care of or anything of that nature. These are the older, more experienced engineers that have a far better technical knowledge on a specific technology.

[MinnFan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I genuinely don't understand how you link this to Trickle Down. To me, it's just short-sighted managers being penny-wise and pound-foolish, straight up - nothing more complicated than that.

Forget it, he's rolling

[MinnFan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

[QUOTE=ScoobyDoo;5516184]

That we have engineers doing things other than just engineering?

No, I don't think it has anything to do with regulations. It has to do with the way we run our companies nowadays.

No, the fact that there has been an explosion in admin positions in industries that gov't has a major influence in. Still trying to figure out how you manage to put the talking point of Trickle Down Economics on that one. Not to mention how you contradict yourself by saying that both additional admin and lack of admin are trickle down.

[LynahFan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Trickle Down Economic Theory 101

I genuinely don't understand how you link this to Trickle Down. To me, it's just short-sighted managers being penny-wise and pound-foolish, straight up - nothing more complicated than that.

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

[QUOTE=joecct;5513439]

Couldn't have anything to do with all the regulations and admin work required by the gov't

That we have engineers doing things other than just engineering?

No, I don't think it has anything to do with regulations. It has to do with the way we run our companies nowadays.

[MinnFan]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Trickle Down Economic Theory 101

Couldn't have anything to do with all the regulations and admin work required by the gov't

You could probably put a nearly identical graph over education