America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Both of your comments are spot on. For those reasons, I'm currently in the process of winding down my outpt practice (Geriatrics) and moving towards being totally a hospitalist. Different set of headaches but still (at least for now) better. I'm kind of sad because I really love caring for the elderly but the hassles are just getting to be too much. When this gets too bad, my next move is to become a prison physician.

This is what is so sad in the system...everything is going piecemeal because no one can handle the garbage.

 

[DrDemento]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

This is what is so sad in the system...everything is going piecemeal because no one can handle the garbage.

Les-Correct. Jenny and I went part time because we found ourselves seeing patients 4 hours per day and spending 5 hours per day on the clerical work.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Les-Correct. Jenny and I went part time because we found ourselves seeing patients 4 hours per day and spending 5 hours per day on the clerical work.

They just put in the bill a 21% cut in reimbursement for Medicare. Most other insurances reimburse on a multiplier of their reimbursement. First- we literally won't be able to afford to take the Medicare patients- you pretty much lose money on them if they are anything but healthy, Then we won't be getting reimbursed enough to see anyone else. There isn't much fat to cut when you are in primary care. This goes thru and there will be even less primary care because no one will go into it (up and coming docs) and there are way too many folks that won't be able to stay afloat who are primary care. I am really scared for the system (not being theatrical). In my area we already are way behind the eight ball for lack of primary care access.

 

[busterman62]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

This is one of the main reasons I'll be dropping primary care. I'm employed in a semi-rural area and see about 75% Medicare. My Pt population is the sickest of the sick that the other area docs don't want to or can't care for. We keep the number of Pts low and usually give each Pt about 30 min/visit. It's very time consuming but the level of Pt need requires it. Unfortunately, the current reimbursement doesn't compensate for that time. The simple economics of the situation is that it's cheaper for my employer to shut my office practice down because we're losing so much money. Most of my Pts will get shifted to the other local docs who probably will be unable to provide the same level of care. (After reading what I just typed, it sounds kind of egotistical but it's really not. I routinely have other local docs refer Pts when they become too complex for them.) We're going to try and see some of those Pts at a clinic in the hospital on a part time basis but I'm not sure how well that's going to work out. From my standpoint, I'll be doing inpt care (which I enjoy), make the same $$ and increase my time off by about 500%. Still, I've got major reservations about all this.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

This is one of the main reasons I'll be dropping primary care. I'm employed in a semi-rural area and see about 75% Medicare. My Pt population is the sickest of the sick that the other area docs don't want to or can't care for. We keep the number of Pts low and usually give each Pt about 30 min/visit. It's very time consuming but the level of Pt need requires it. Unfortunately, the current reimbursement doesn't compensate for that time. The simple economics of the situation is that it's cheaper for my employer to shut my office practice down because we're losing so much money. Most of my Pts will get shifted to the other local docs who probably will be unable to provide the same level of care. (After reading what I just typed, it sounds kind of egotistical but it's really not. I routinely have other local docs refer Pts when they become too complex for them.) We're going to try and see some of those Pts at a clinic in the hospital on a part time basis but I'm not sure how well that's going to work out. From my standpoint, I'll be doing inpt care (which I enjoy), make the same $$ and increase my time off by about 500%. Still, I've got major reservations about all this.

What I am wondering, because this scenario is playing out all across the country, who is going to take care of these folks. With all the HEDIS measures and benchmarks a practice gets punished for even having them on the panel. If you take the time you lose so much monuey it isn't viable. If they move to a practice that can't take the time then that practice loses a ton of withhold because they can't possible monitor and manage everything in a 15 minute visit. Pretty soon you have NO ONE that will take these folks. This is the untimate rationing- they are making it so hard to care for the sickies they won't be able to find a practice to take them.

Everyone keeps ranting about no public option and how the system is bloated. They need to look at either cutting the real bloat or providing somewhere all the medical orphans are going to go when they make it literally impossible for folks to provide primary care.

 

[St. Clown]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Pretty soon you have NO ONE that will take these folks. This is the untimate rationing- they are making it so hard to care for the sickies they won't be able to find a practice to take them.

Not to be too glib, but perhaps that's the point.

Medicare's cost overruns are much higher than they anticipated. Imagine the overruns if the program actually provided the funds to care for people as we expect.

 

[busterman62]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Not to be too glib, but perhaps that's the point.

Medicare's cost overruns are much higher than they anticipated. Imagine the overruns if the program actually provided the funds to care for people as we expect.

Death IS cost-effective!

 

[busterman62]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

What I am wondering, because this scenario is playing out all across the country, who is going to take care of these folks. With all the HEDIS measures and benchmarks a practice gets punished for even having them on the panel. If you take the time you lose so much monuey it isn't viable. If they move to a practice that can't take the time then that practice loses a ton of withhold because they can't possible monitor and manage everything in a 15 minute visit. Pretty soon you have NO ONE that will take these folks. This is the untimate rationing- they are making it so hard to care for the sickies they won't be able to find a practice to take them.

Everyone keeps ranting about no public option and how the system is bloated. They need to look at either cutting the real bloat or providing somewhere all the medical orphans are going to go when they make it literally impossible for folks to provide primary care.

Some nearby systems are already doing this. We're getting requests from Pts 40-50 miles away.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Some nearby systems are already doing this. We're getting requests from Pts 40-50 miles away.

We have 2 practices in our area taking new patients (one just opened) but just lost 2 long time FP guys who just packed it in. We have scores of patients who are unable to find a primary care provider. Even the new places don't take some of the insurances.

I love what I do but I seriously think sometimes of what else I could be doing. Perfectionist that I am, I can't stand that I am unable and at times prohibited from doing the best for the patient. Makes me sick. Even if people woke up right away, if they pulled their collective heads outta their anal orrifices, (and they won't for awhile- look at what they have to say currently) it would take until I retire for them to fix things

 

[DrDemento]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Les: The feeling that we were being prohibited from doing what is best for the patient is what has driven us to semi retire. I was fortunate enough to be in medicine for long enough to have at least experienced the time when I could provide what my patients needed. As a skin cancer surgeon, I am every bit the perfectionist-the frustrations that have crept into the practice of medicine will now only increase. I don't miss the hours of fighting with HMO's, Medicare, and insurance companies just to get reimbursement for my patients. What I do miss is the patient contact-I had seen over 48,000 new patients in over 30 years of practice and honestly felt they were all like family.

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I have been in Family Practice for more than 20 yrs- taken care of 5 generation families, see families where I took care of the Mums when they were pregnant with the kids and kids that are now having kids. As you say, these people aren't just numbers. The politicians look at numbers, the insurance companies look at numbers- meanwhile people are getting underserved. I am not old enough to retire- not getting rich doing what I am doing so can't see it happening soon. Maybe I should by a Florist shop.....

I was in it when taking care of patients was what you did too. Do you ever wonder what the heck they are teaching the new folks coming down the pipeline? That is depressing.

 

[DrDemento]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I have been in Family Practice for more than 20 yrs- taken care of 5 generation families, see families where I took care of the Mums when they were pregnant with the kids and kids that are now having kids. As you say, these people aren't just numbers. The politicians look at numbers, the insurance companies look at numbers- meanwhile people are getting underserved. I am not old enough to retire- not getting rich doing what I am doing so can't see it happening soon. Maybe I should by a Florist shop.....

I was in it when taking care of patients was what you did too. Do you ever wonder what the heck they are teaching the new folks coming down the pipeline? That is depressing.

The new kids coming out of training are usually in so much debt that they will accept anything handed to them as long as they eke out a living. Unless their parents were fortuante enough to practice in the old days-they have no concept of what it was like and just accept the status quo. The shame, as you have said repeatedly, is the patients are suffering(and many of them dont even realize that they are).

 

[busterman62]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I have been in Family Practice for more than 20 yrs- taken care of 5 generation families, see families where I took care of the Mums when they were pregnant with the kids and kids that are now having kids. As you say, these people aren't just numbers. The politicians look at numbers, the insurance companies look at numbers- meanwhile people are getting underserved. I am not old enough to retire- not getting rich doing what I am doing so can't see it happening soon. Maybe I should by a Florist shop.....

I was in it when taking care of patients was what you did too. Do you ever wonder what the heck they are teaching the new folks coming down the pipeline? That is depressing.

I appear to be the baby of the bunch. Just starting my 20th year.

Most of us get into medicine to care for patients. The system and the economics dictate that we must treat patients. When I start treating more patients than I care for I'll switch to dealing Blackjack in Vegas.

 

[ScoobyDoo]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

It's not affordable. Sad thing is what we have now isn't affordable either.

Wheeeeeeeeeeee.....................

 

[joecct]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Question. AAHCA2009 passes. What if it does not achieve its goals (accessability, choice, costs)? Can it be undone?

 

[leswp1]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

5) DATA DIGEST: Poor access to care
The American Medical Association has released an analysis of Medicare patients' "access to care" on a state by state basis. The report identifies 21 states and the District of Columbia where access is severely compromised or in crisis, calling them "Patient Access Hot Spots." These states were ranked in the top 15 for at least two of five measures of poor access to care:

Alabama, Arkansas, District of Columbia, Florida, Georgia, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Mississippi, Montana, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, West Virginia, and Wyoming.

To find state specific data, visit the AMA Web site and read the Medicare Payment Action Kit.

From:
http://www.physicianspractice.com/

So this is why I am whining- living in one of those states.

 

[mookie1995]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I appear to be the baby of the bunch. Just starting my 20th year.

Most of us get into medicine to care for patients. The system and the economics dictate that we must treat patients. When I start treating more patients than I care for I'll switch to dealing Blackjack in Vegas.

i hope you're a looker with a nice rack!

 

[sagard]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Question. AAHCA2009 passes. What if it does not achieve its goals (accessability, choice, costs)? Can it be undone?

Sure if the Repubs truly don't like it, they can make changes or eliminate things the next time they are in power. I suspect they will have better things to worry about though.

 

[Kepler]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Question. AAHCA2009 passes. What if it does not achieve its goals (accessability, choice, costs)? Can it be undone?

It becomes part of the democratic process -- if it's popular, it won't be rolled back, if it's unpopular, it will be amended or scrapped. Pure ideological opposition won't be enough to kill it (c.f., social security, Medicare), but it will always have to fight a strong headwind of special interests that those do not.

 

[Patman]

Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

It becomes part of the democratic process -- if it's popular, it won't be rolled back, if it's unpopular, it will be amended or scrapped. Pure ideological opposition won't be enough to kill it (c.f., social security, Medicare), but it will always have to fight a strong headwind of special interests that those do not.

it'll remain popular even if it doesn't work... we have a news media who wholly believes that its proper and moral.