For those of you who may be following my blog, it may seem as though I've not made any recent posts. The truth of the matter is that I changed over to a TypePad blog and neglected to inform all of you. My apologies for this. Things have been a bit busy and I've not been able to complete my website redesign in the timeframe I initially intended. Nonetheless, if you are still interested in following my posts, please visit ocfm.typepad.com
As always, my thanks
Wednesday, October 29, 2008
Tuesday, July 01, 2008
41 Secrets Your Doctor Would Never Share
From Reader’s Digest:
<http://www.rd.com/living-healthy/41-medical-secrets/article75920-2.html>
I’d like to make a couple of additional comments to perhaps provide a better sense of reality. Although the prices listed are....well...conservative (meaning the cost is higher), the one *major* item the article fails to put forth is that although the “doctor’s bill” may be $100, the actual reimbursment (ie payment from insurance carrier) is somewhere around $50 (!) - maybe $60. So, doing a bit of quick math, you can see how most, virtually all, of independent physicians have a very difficult time making ends meet.
Interestingly, I learned that the fellow down the road who replaces your windshield wipers gets paid more (when all is said and done, remember he doesn’t have the expenses) than I do if I inject your shoulder, see your sick child for an ear infection, take care of you in the hospital, et al.
<http://www.rd.com/living-healthy/41-medical-secrets/article75920-2.html>
I’d like to make a couple of additional comments to perhaps provide a better sense of reality. Although the prices listed are....well...conservative (meaning the cost is higher), the one *major* item the article fails to put forth is that although the “doctor’s bill” may be $100, the actual reimbursment (ie payment from insurance carrier) is somewhere around $50 (!) - maybe $60. So, doing a bit of quick math, you can see how most, virtually all, of independent physicians have a very difficult time making ends meet.
Interestingly, I learned that the fellow down the road who replaces your windshield wipers gets paid more (when all is said and done, remember he doesn’t have the expenses) than I do if I inject your shoulder, see your sick child for an ear infection, take care of you in the hospital, et al.
Open Letter from America's Physicians
An Open Letter from America's Physicians
Dear Fellow Americans,
For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources. Unfortunately, our healthcare system has lost focus to the point where patient well-being is placed after politics, profits, and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care.
- Our heavily fragmented healthcare system has made it very difficult for you, the American public, to get the care you need. As your physicians, we want to partner with you to address the critical defects of the system as outlined below:
- You are paying a lot for healthcare and not receiving enough in return. Your insurance premiums continue to increase while your healthcare options are dwindling. Gatekeepers, insurance networks, and restrictive regulations limit your choice of doctors and your access to care.
- You have been made dependent on complicated and expensive health insurance plans. Employers are forced to take money out of your paycheck to purchase health coverage. If you lose your job, you are left with no safety net and the money you have paid for health coverage vanishes.
- The time you spend with your physician has become remarkably brief due to regulatory hurdles requiring doctors to spend more time on documentation than with you.
- The insurance industry's undue authority and oppressive control over healthcare processes
- Excessive and misguided government regulation
- The practice of defensive medicine in response to a harmful and costly legal environment
The Undersigned U.S. Physicians
Saturday, March 15, 2008
Monday, January 07, 2008
Sunday, December 16, 2007
Only a few more days!
Most of you will undoubtedly read the opening line and presume I am wishing happy holidays to everyone. Well, I am, however, I’m also writing in reference to the upcoming 10.1% cut in Medicare reimbursement to physicians.
You may be wondering why this is a big deal. Well for one, it will make it harder and harder for Family Physicians, such as myself to continue providing medical care to Medicare recipients. Why? Well, over the past several years, reimbursement for physician services, specifically to family physicians, has steadily declined. As the cost of running an office rises, ie heat, electricity, staff, equipment, et al, rises, the difference between income and expenses broadens and is soon reaching a point where reimbursement does not cover the cost of providing the care.
I would kindly ask everyone (if anyone is actually reading this blog) to contact Senators Snowe and Collins to stop the pending cuts.
To quote the Bartles and Jaymes commercial, thanks for your support.
You may be wondering why this is a big deal. Well for one, it will make it harder and harder for Family Physicians, such as myself to continue providing medical care to Medicare recipients. Why? Well, over the past several years, reimbursement for physician services, specifically to family physicians, has steadily declined. As the cost of running an office rises, ie heat, electricity, staff, equipment, et al, rises, the difference between income and expenses broadens and is soon reaching a point where reimbursement does not cover the cost of providing the care.
I would kindly ask everyone (if anyone is actually reading this blog) to contact Senators Snowe and Collins to stop the pending cuts.
To quote the Bartles and Jaymes commercial, thanks for your support.
Thursday, December 13, 2007
Planned Medicare Cuts Weigh On Primary Care
From the Wall Street Journal (http://online.wsj.com/article/SB119732809319620055.html?mod=moj_columnis)
Planned Medicare Cuts Weigh on Primary Care December 11, 2007
While presidential candidates are beating each other up about their plans for the uninsured, they've taken their eye off another big issue. Access to primary care for millions of people enrolled in Medicare is in peril.
As each new year approaches, doctors across the country brace for cuts in payments from Medicare. Unless there's a reprieve soon, Medicare will reduce payments to doctors by an average of 10.1% starting Jan. 1. (See the details here). Last year a planned reduction of 5% was averted by Congress at the last minute and payments stayed about flat.
Another deal remains possible. But the constant threat of decreases and the absence of increases in recent years are leading doctors to re-think their commitment to caring for Medicare patients. The question is becoming acute for primary care doctors, who are faring worse than those in other specialties.
To see why, it's worth a quick look to see how Medicare calculates how much to pay a doctor for care. There's a complex formula, but one of the keys is something called a work relative value unit that Medicare assigns to doctors' activities based on their specialties. An hour of brain surgery is valued more highly than an hour of general medical care.
Where a doctor practices also influences the payment calculation. Rural health clinics like mine operate under a special government program and will likely get a small cost of living adjustment next year.
In the end, Medicare multiplies a total relative value unit, factoring in various adjustments, by a payment benchmark to come up with fees for physician services. (For more, see this summary from the American Medical Association.)
The formula means that there are two ways for doctors to gain or lose under Medicare. The benchmark can be adjusted up or down, affecting all doctors. And the modifiers assigned to each specialty can be increased or decreased. Adjustment of the financial weight given to specialties is generally a zero-sum game and that pits one group of doctors against another in the lobbying wars.
Family medicine has been a loser, with its modifier decreasing since 2001. My medical school classmates who opted for anesthesiology are in line for a 4% increase next year. Coupling the lower payment factor for family medicine with the planned 10.1% drop in the benchmark for Medicare equals a big hit to primary care.
The Medicare crunch has been a big topic of conversation in an online discussion group on practice management run by the American Academy of Family Physicians. I'm a member and have found the chatter a little depressing.
As you might imagine, some doctors predict more grumbling and then eventual acceptance of what would amount to a salary cut for seeing Medicare patients.
Some expect to see more Medicare patients to make up for cuts with higher volume. Dr. Shane Avery, a solo practitioner in Scottsburg, Ind., will ask patients to come to the office for everything, no matter how small. Medicare doesn't pay enough to cover his overhead for the range of services he provides outside of an office visit, such as phone consultations.
Dr. Kathy Saradarian of Branchville, N.J., predicts Medicare cuts will prompt doctors to see patients more often but spend less time during each visit. But even that adjustment may not be enough. In her area of New Jersey, insurance payments are so low that Medicare is her best payer. Any cuts will come right off her bottom line. "They think we can make up the losses in other ways, but we can't," she says. "It is disheartening."
Others are considering dropping out of Medicare altogether. Dr. Marie Steinmetz, of Alexandria, Va., stopped taking Medicare six years ago because the payments didn't cover her expenses. Her practice offers traditional medical care with complementary and alternative medicine that insurance generally doesn't pay for anyway.
A family doctor in rural California named Deborah Sutcliffe stopped taking new Medicare patients two years ago. Now she's thinking about requiring her remaining Medicare patients to pay her directly rather than taking her fee via Medicare. If she goes this route, she's allowed to charge a slightly higher price. Medicare sends partial reimbursement for the office visit to the patient, and the patient pays the difference. This approach usually results in more overhead for a practice, but the total collections for the same sorts of visits can be 15% higher.
Elizabeth Pector, a family practitioner in Naperville, Ill., worries most about the effect a Medicare cut could have on other insurers. Many tie their reimbursement to Medicare. If the private sector rates drop 10%, too, her practice could be in big trouble. She worries about the health and options for our seniors, but finds herself worrying more urgently about the health of her practice.
While everyone's talking about how to expand health care for the uninsured, I think it's time to fix the Medicare system that's leading many doctors who tend to the basic health-care needs of the elderly to reconsider the proposition.
Planned Medicare Cuts Weigh on Primary Care December 11, 2007
While presidential candidates are beating each other up about their plans for the uninsured, they've taken their eye off another big issue. Access to primary care for millions of people enrolled in Medicare is in peril.
As each new year approaches, doctors across the country brace for cuts in payments from Medicare. Unless there's a reprieve soon, Medicare will reduce payments to doctors by an average of 10.1% starting Jan. 1. (See the details here). Last year a planned reduction of 5% was averted by Congress at the last minute and payments stayed about flat.
Another deal remains possible. But the constant threat of decreases and the absence of increases in recent years are leading doctors to re-think their commitment to caring for Medicare patients. The question is becoming acute for primary care doctors, who are faring worse than those in other specialties.
To see why, it's worth a quick look to see how Medicare calculates how much to pay a doctor for care. There's a complex formula, but one of the keys is something called a work relative value unit that Medicare assigns to doctors' activities based on their specialties. An hour of brain surgery is valued more highly than an hour of general medical care.
Where a doctor practices also influences the payment calculation. Rural health clinics like mine operate under a special government program and will likely get a small cost of living adjustment next year.
In the end, Medicare multiplies a total relative value unit, factoring in various adjustments, by a payment benchmark to come up with fees for physician services. (For more, see this summary from the American Medical Association.)
The formula means that there are two ways for doctors to gain or lose under Medicare. The benchmark can be adjusted up or down, affecting all doctors. And the modifiers assigned to each specialty can be increased or decreased. Adjustment of the financial weight given to specialties is generally a zero-sum game and that pits one group of doctors against another in the lobbying wars.
Family medicine has been a loser, with its modifier decreasing since 2001. My medical school classmates who opted for anesthesiology are in line for a 4% increase next year. Coupling the lower payment factor for family medicine with the planned 10.1% drop in the benchmark for Medicare equals a big hit to primary care.
The Medicare crunch has been a big topic of conversation in an online discussion group on practice management run by the American Academy of Family Physicians. I'm a member and have found the chatter a little depressing.
As you might imagine, some doctors predict more grumbling and then eventual acceptance of what would amount to a salary cut for seeing Medicare patients.
Some expect to see more Medicare patients to make up for cuts with higher volume. Dr. Shane Avery, a solo practitioner in Scottsburg, Ind., will ask patients to come to the office for everything, no matter how small. Medicare doesn't pay enough to cover his overhead for the range of services he provides outside of an office visit, such as phone consultations.
Dr. Kathy Saradarian of Branchville, N.J., predicts Medicare cuts will prompt doctors to see patients more often but spend less time during each visit. But even that adjustment may not be enough. In her area of New Jersey, insurance payments are so low that Medicare is her best payer. Any cuts will come right off her bottom line. "They think we can make up the losses in other ways, but we can't," she says. "It is disheartening."
Others are considering dropping out of Medicare altogether. Dr. Marie Steinmetz, of Alexandria, Va., stopped taking Medicare six years ago because the payments didn't cover her expenses. Her practice offers traditional medical care with complementary and alternative medicine that insurance generally doesn't pay for anyway.
A family doctor in rural California named Deborah Sutcliffe stopped taking new Medicare patients two years ago. Now she's thinking about requiring her remaining Medicare patients to pay her directly rather than taking her fee via Medicare. If she goes this route, she's allowed to charge a slightly higher price. Medicare sends partial reimbursement for the office visit to the patient, and the patient pays the difference. This approach usually results in more overhead for a practice, but the total collections for the same sorts of visits can be 15% higher.
Elizabeth Pector, a family practitioner in Naperville, Ill., worries most about the effect a Medicare cut could have on other insurers. Many tie their reimbursement to Medicare. If the private sector rates drop 10%, too, her practice could be in big trouble. She worries about the health and options for our seniors, but finds herself worrying more urgently about the health of her practice.
While everyone's talking about how to expand health care for the uninsured, I think it's time to fix the Medicare system that's leading many doctors who tend to the basic health-care needs of the elderly to reconsider the proposition.
Tuesday, December 11, 2007
Message for the New Year
Received this via e-mail and although I can’t validate it, the message has been attributed to George Carlin. Regardless of it’s original source, the message is one that I certainly took to heart and one that I would encourage off of us to think about from time to time.
A Message by George Carlin: The paradox of our time in history is that we have taller buildings but shorter tempers, wider Freeways , but narrower viewpoints. We spend more, but have less, we buy more, but enjoy less. We have bigger houses and smaller families, more conveniences, but less time. We have more degrees but less sense, more knowledge, but less judgment, more experts, yet more problems, more medicine, but less wellness.
We drink too much, smoke too much, spend too recklessly, laugh too little, drive too fast, get too angry, stay up too late, get up too tired, read too little, watch TV too much, and pray too seldom.
We have multiplied our possessions, but reduced our values. We talk too much, love too seldom, and hate too often.
We've learned how to make a living, but not a life. We've added years to life not life to years. We've been all the way to the moon and back, but have trouble crossing the street to meet a new neighbor. We conqu e red outer space but not inner space. We've done larger things, but not better things.
We've cleaned up the air, but polluted the soul. We've conquered the atom, but not our prejudice. We write more, but learn less. We plan more, but accomplish less. We've learned to rush, but not to wait. We build more computers to hold more information, to produce more copies than ever, but we communicate less and less.
These are the times of fast foods and slow digestion, big men and small character, steep profits and shallow relationships. These are the days of two incomes but more divorce, fancier houses, but broken homes. These are days of quick trips, disposable diapers, throwaway morality, one night stands, overweight bodies, and pills that do everything from cheer, to quiet, to kill. It is a time when there is much in the showroom window and nothing in the stockroom. A time when technology can bring this letter t o you, and a time when you can choose either to share this insight, or to just hit delete...
Remember; spend some time with your loved ones, because they are not going to be around forever.
Remember, say a kind word to someone who looks up to you in awe, because that little person soon will grow up and leave your side.
Remember, to give a warm hug to the one next to you, because that is the only treasure you can give with your heart and it doesn't cost a cent.
Remember, to say, "I love you" to your partner and your loved ones, but most of all mean it. A kiss and an embrace will mend hurt when it comes from deep inside of you.
Remember to hold hands and cherish the moment for someday that person will not be there again.
Give time to love, give time to speak! And give time to share the precious thoughts in your mind.
AND ALWAYS REMEMBER:
Life is not measured by the number of breaths we take, but by the moments that take our breath away.
If you don't send this to at least 8 people....Who cares?
George Carlin
A Message by George Carlin: The paradox of our time in history is that we have taller buildings but shorter tempers, wider Freeways , but narrower viewpoints. We spend more, but have less, we buy more, but enjoy less. We have bigger houses and smaller families, more conveniences, but less time. We have more degrees but less sense, more knowledge, but less judgment, more experts, yet more problems, more medicine, but less wellness.
We drink too much, smoke too much, spend too recklessly, laugh too little, drive too fast, get too angry, stay up too late, get up too tired, read too little, watch TV too much, and pray too seldom.
We have multiplied our possessions, but reduced our values. We talk too much, love too seldom, and hate too often.
We've learned how to make a living, but not a life. We've added years to life not life to years. We've been all the way to the moon and back, but have trouble crossing the street to meet a new neighbor. We conqu e red outer space but not inner space. We've done larger things, but not better things.
We've cleaned up the air, but polluted the soul. We've conquered the atom, but not our prejudice. We write more, but learn less. We plan more, but accomplish less. We've learned to rush, but not to wait. We build more computers to hold more information, to produce more copies than ever, but we communicate less and less.
These are the times of fast foods and slow digestion, big men and small character, steep profits and shallow relationships. These are the days of two incomes but more divorce, fancier houses, but broken homes. These are days of quick trips, disposable diapers, throwaway morality, one night stands, overweight bodies, and pills that do everything from cheer, to quiet, to kill. It is a time when there is much in the showroom window and nothing in the stockroom. A time when technology can bring this letter t o you, and a time when you can choose either to share this insight, or to just hit delete...
Remember; spend some time with your loved ones, because they are not going to be around forever.
Remember, say a kind word to someone who looks up to you in awe, because that little person soon will grow up and leave your side.
Remember, to give a warm hug to the one next to you, because that is the only treasure you can give with your heart and it doesn't cost a cent.
Remember, to say, "I love you" to your partner and your loved ones, but most of all mean it. A kiss and an embrace will mend hurt when it comes from deep inside of you.
Remember to hold hands and cherish the moment for someday that person will not be there again.
Give time to love, give time to speak! And give time to share the precious thoughts in your mind.
AND ALWAYS REMEMBER:
Life is not measured by the number of breaths we take, but by the moments that take our breath away.
If you don't send this to at least 8 people....Who cares?
George Carlin
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