Date: January 13, 2005 4:52 PM
Topic: Thoughts on Convocation
Well, having recently returned from the AAO Convocation, I must say
that overall, I think the Convocation went well. The major downside
to the entire event is that the "environment"
Date: September 17, 2005 9:35 AM
Topic: Future of Family Medicine
So, where is the specialty of Family Medicine headed? It seems that
at every corner, Family Physicians are becoming less and less
prevalent. Over time, less and less Family Docs did OB, now fewer are
doing in-patient work. How is it that our Society/College/National
organizations have allowed this parsing to take place? And, more
importantly, where will "Family Medicine" be in another year?
I recall a comment my GP (that's what the term was then) made to me
at my sister's wedding in reference to the Hospitalist movement; "why
is it that when a patient is the sickest and needs their Doctor the
most, their Doctor abandons them to someone else?". This comment
continues to stick with me whenever I hear of another Family Doc
"gives up" their hospital work.
Comments?
Date: December 8, 2005 5:12 PM
Topic: Can't quite believe it
Can't quite believe this article, but seems to be "open hunting
season" on Physicians (ie, more and more articles like this coming out)
http://www.msnbc.msn.com/id/10349325/
See, the problem I have with this article isn't that I support this
particular Physician's "fee", but moreso that the author failed to
comment on the global "shafting" Physicians are taking. Let me share
a few examples....
1. Insurance company's frequent changing of the rules, altering
physician billing, undercutting physician reimbursement
2. Dropping Medicare reimbursement to Physicians, in particular,
Family Physicians
3. Pending "pay-for-performance" requirements for reimbursement.
While I agree with being "paid" to provide excellent medical care,
why is it that I should be "punished" (ie not reimbursed) if a
patient refuses the recommended medical care?
4. Decreasing graduate medical education funds for the training of
new physicians
5. "bundling" by insurance companies, that is refusing to pay for
more than one service on the same day
6. the list continues
Comments?
Date: July 6, 2006 6:42 PM
Topic: Beginning of a new year
So, it's about this time of the year when the hospitals are flooded
with new resident physicians, affectionately called "interns".
Fortunately for us, we have a great new group of vivacious and
energetic resident physicians who are now in the midst of the first
real week of residency (okay, week #2, but who's counting the typical
orientation material anyway?)
This is also the time of year when graduating residens enter the vast
world of attending-dom. The buck stops with them now.
As each enters their own phase of their new lives, what should they
look forward to?
Well, gone are the completely endless nights of call and >24 hours
per shift (I had the dubious privilege of being the last class to
experience this wonderous opportunity), however, our "new" physicians
will begin to experienced the glorious world of prior authorizations,
preferred medication list
Date: July 26, 2006 12:52 PM
Topic: Sorry, no payment
So, the Government decides that Physicians and Health Care
Organizations will just have to do without
September is payment free
Interesting that the Government is able to make this unilateral
decision when, if the situation were reveresed, they certainly
wouldn't feel the same way (can I skip a few days worth of bills?)
Date: August 29, 2006 4:38 PM
Topic: Call me paranoid
I'll admit that I can be a bit on the paranoid site when it comes to
the integration of technology in our lives, but this (VeriChip Sells
First Baby Protection System) really got my attention.
I remember, several years ago (in fact little over a decade) reading
a snippet from a purported conspiracy newsletter than made mention of
this technology and the eventual integration into our daily lives.
Now, although this article paints the picture of safety, I can't help
but wonder what devious plans the great "Big Brother" powers may have
for technology such as this.
Will there come a day when such implanted technology is required?
What is there to stop this eventuality?
Blogged with Flock
Date: September 2, 2006 11:52 AM
Topic: "Primary Care Physician"
I do not practice "Family Practice" nor do I see patients in a
"clinic". For that matter, I am not a "Primary Care Provider", but
rather I provide medical care to a wide range of ages; birth to
death, unfortunately taxes in between. So what is the best title to
have? Am I a "GP" or an "FP"?
Rather than words, it's actions which define who someone is...take
for example the thousands, likely millions of people who wear gold
crosses around their neck, yet their actions do not represent the
tenets of "Christianity". Or perhaps, the "Republican" who claims to
be a conservative, yet abhors "conservative values". Perhaps the
"Liberal" who preaches tolerance, yet won't let citizens express
philosophical/political/religious views which differ from their own.
One of the problems in "Family Medicine" is that this specialty
(which historically served as the foundation for nearly all other
specialties) is allowing itself to be labeled by those who know very
little about what it means to provide the "full spectrum of care".
Take for example the following "definitions" for "Family Medicine"
from a variety of specialites...
-Pediatrics: something other than kids, unless of course the young
lady begins her menstrual cycle when she should, of course, see a
gynecologist
-Internal Medicine: obviously nothing overly complicated as they
don't have the expertise in managing chronic disease that our
specialty training offers
-Obstetrics: something other the pregnant women who should only see
our specialty, that is unless I hire a CNM whom I have given
clearance (c'mon CNM's fight back!)
-Gastroenterologists: just don't do colonoscopies or endoscopies.
These are very trick procedures...what you've done 1000? Well, when
you reach 2000, I'll reconsider
-Cardiology: just don't read EKG's
-Hospitalists: yes, when your patients are the sickest and need to be
admitted, you should really turn them over to us, after all, it's a
financial loss for your office if you "have to" care for your own
patients
Shall I go on?
The specialty of "Family Medicine" needs to grow a big set of
cajones. We need to revitalize the specialty and reinvigorate the
masses. We need to stop allowing other forces (hospitals, insurance
carriers, specialites, media, impotent colleagues) to define who we are.
Date: August 29, 2007 11:29 AM
Topic: Sorry, no payment here
Date: July 26, 2006 12:52 PM
Topic: Sorry, no payment
So, the Government decides that Physicians and Health Care
Organizations will just have to do without
September is payment free
Interesting that the Government is able to make this unilateral
decision when, if the situation were reveresed, they certainly
wouldn't feel the same way (can I skip a few days worth of bills?)
Date: August 29, 2006 4:38 PM
Topic: Call me paranoid
I'll admit that I can be a bit on the paranoid site when it comes to
the integration of technology in our lives, but this (VeriChip Sells
First Baby Protection System) really got my attention.
I remember, several years ago (in fact little over a decade) reading
a snippet from a purported conspiracy newsletter than made mention of
this technology and the eventual integration into our daily lives.
Now, although this article paints the picture of safety, I can't help
but wonder what devious plans the great "Big Brother" powers may have
for technology such as this.
Will there come a day when such implanted technology is required?
What is there to stop this eventuality?
Blogged with Flock
Date: September 2, 2006 11:52 AM
Topic: "Primary Care Physician"
I do not practice "Family Practice" nor do I see patients in a
"clinic". For that matter, I am not a "Primary Care Provider", but
rather I provide medical care to a wide range of ages; birth to
death, unfortunately taxes in between. So what is the best title to
have? Am I a "GP" or an "FP"?
Rather than words, it's actions which define who someone is...take
for example the thousands, likely millions of people who wear gold
crosses around their neck, yet their actions do not represent the
tenets of "Christianity". Or perhaps, the "Republican" who claims to
be a conservative, yet abhors "conservative values". Perhaps the
"Liberal" who preaches tolerance, yet won't let citizens express
philosophical/political/religious views which differ from their own.
One of the problems in "Family Medicine" is that this specialty
(which historically served as the foundation for nearly all other
specialties) is allowing itself to be labeled by those who know very
little about what it means to provide the "full spectrum of care".
Take for example the following "definitions" for "Family Medicine"
from a variety of specialites...
-Pediatrics: something other than kids, unless of course the young
lady begins her menstrual cycle when she should, of course, see a
gynecologist
-Internal Medicine: obviously nothing overly complicated as they
don't have the expertise in managing chronic disease that our
specialty training offers
-Obstetrics: something other the pregnant women who should only see
our specialty, that is unless I hire a CNM whom I have given
clearance (c'mon CNM's fight back!)
-Gastroenterologists: just don't do colonoscopies or endoscopies.
These are very trick procedures...what you've done 1000? Well, when
you reach 2000, I'll reconsider
-Cardiology: just don't read EKG's
-Hospitalists: yes, when your patients are the sickest and need to be
admitted, you should really turn them over to us, after all, it's a
financial loss for your office if you "have to" care for your own
patients
Shall I go on?
The specialty of "Family Medicine" needs to grow a big set of
cajones. We need to revitalize the specialty and reinvigorate the
masses. We need to stop allowing other forces (hospitals, insurance
carriers, specialites, media, impotent colleagues) to define who we are.
Date: August 30, 2007 12:22 AM
Topic: Learning along the way
As many of you know, come October 1, 2007, I'll be heading into the
wonderful world of "private practice". As someone who prided himself
in constantly being educated in the areas of practice management,
billing and coding, etc, it's actually been a very frustrating
experience.
Not frustrating from a lack of understanding, but rather from the
fact that I have ZERO negotiating power. Third party payors are
holding nearly all the marbles. Now, this is certainly not a posting
to advocate for a single-payor healthcare system, which would be a
complete disaster, but rather a deeper realization of how bass-
ackwards the "system" is.
For example, typically when you "contract" with someone to perform a
job, the involved parties agree on some basic tenets...I'd like to
have the project completed by such-and-such a time and I'd like it
done within certain parameters; sky blue, not navy blue; all 4 walls
rather than just 3. I'm not going to dictate to you how you actually
paint a wall, but rather judge the work process by the end result.
This is not the case with the "practice" of medicine. Over the next
few blog postings, I'll be sharing some seemingly odd discrepancies
in the professional agreements or "contracts" physicians have with
payors (ie, insurance carries), but let me begin with a payor near
and dear to my heart (cough - cough)....Medicare.
About 2 months ago, and knowing I would be moving into private
practice, I contacted our lovely government-run insurance carrier.
You know one of the ones which we as tax payers dump loads of money
into? I contacted them seemingly far enough in advance to prevent
any delay in the "credentialling" process and to ensure that all of
my contact information, etc was updated.
As I would be forming a group practice, I would need to apply for a
Group NPI (national provider identification) on top of my already
existing personal NPI, UPIN (universal physician identification
number) and Medicare ID number. Now one would think that a single ID
# would suffice. "We" were told that at some point it
"will" (although everyone was supposed to adopt this new-and-improved
system in May, 2007) be adopted as THE number physicians and
provider are assigned and all previous numbers would evaporate.
So, like a good little compliant physician, I complete the...hmmm...5
forms??? and submitted then, as directed and with enough advance
notice that by opening day everything would be in order.
This past Monday I received notification that I had submitted my
paperwork "too soon" and would have to resubmit every wonderful piece
of paperwork within the "mandated" 30-day window. Now here's one of
the catches...you can't submit it until within 30-days of your new
office, but Medicare has up to 120 days to review and if everything
is in order, stamp the necessary paperwork with the almighty
"approved" designation.
When I questioned the representative about this because frankly it
doesn't make sense that I had to submit the documents within 30 days,
but they can take an additional 90 to "review things", I was, in so
many words, told....silly Doctor, Trix are for kids!
So, my options at this point include:
1. crap load of prayer that everything will be in order
2. float the gov't a loan by seeing Medicare patients over the next
couple of months and provided all of my documents are in order,
submit the claims afterward. So, if I see half a dozen Medicare
patients.....let's do the math....heck, it's too late for math, but
the long and short of it is that I'll be dutifully providing medical
services which may or may not be reimbursed in a timely fashion and
not until after it's been proven that I am a physician and in fact,
do care for Medicare patients.
An additional frustration is that this is now the 3rd time I've had
to go through this process in the past 5 years. I feel fortunate
because I have way too much time on my hands and I couldn't be more
thankful that the gov't gives me the opportunity to keep myself
occupied with the revolving door of credentialling.
Now, of course, it is now 48 hours + since receiving the notification
above and although I was assured that "I'll call you back", I've not
heard hide nor tail of the representative (or stand-in) that I spoke
with. Patients is a virtue, but really.....
So, we'll see what happens over the course of the next day or so and
hopefully if I don't get a response by Friday, see if anyone actually
remembers the on-going conversations I've had this week and last
Stay tuned........
