A whole slew of Medicare claims are rejecting if the last name does not include the "Jr" that the patient may or may not have on his Medicare ID card. Really? This level of nitpicking is unprecedented.
I really will laugh the loudest when they start denying procedures and hospitalizations left and right. It's coming. I, for one, am glad. The abuses that people inflict on Medicare, "I paid into it so I have a right to have this". Dude, it's not your personal account. It's not your personal property. It's an entitlement conferred onto you by the largesse of the US govt.
Clear Stream
Wednesday, December 5, 2012
Monday, October 15, 2012
Inspiring speech by Marilyn Singleton, MD JD
I am re-posting this inspirational speech made y Dr Marilyn Singleton at the AAPS meeting, she is running for congress in California. She is fed up and makes amazing points here. I wish her all the success, more people who think like this are needed everywhere!
"I was born to be a physician. My grandfather was one of two black students in the 1911 graduating class of Starling Ohio Medical College. He dedicated his life to medicine and helping the low-income folks of Lima, Ohio. My father became an Army Air Force flight surgeon at Tuskegee. As a general practitioner in San Diego, he charged patients what they could afford.Many times we were paid in tamales.
Then came Medicaid. It prohibited doctors from being able to use charity like this. We had high hopes when The Great Society was born: the end of poverty, the end of racial strife. These poverty programs were good intentions gone awry. What social engineer devised a diabolical program forcing a mother in hardship to eject her children’s father from the house in order to get financial assistance? The road to hell began with this kind of “social justice.” Common sense tells me that families in trouble would derive strength from staying together.
The results of the disintegration of the family are fully evident. Unwed motherhood has almost tripled since the 1960s War on Poverty. Seventy-two per cent of Black and fifty-three per cent of Hispanic children are now born to single mothers. Single motherhood quadruples the chance of living in poverty.
Things have gotten worse, not better. Politicians are so arrogant they tell people to “Trust me!” based on faith, not facts. Are we to believe that it works to treat people like helpless victims? The fact is the poverty rate has not changed in 40 years. Are we to believe that a check from a distant rich Uncle (Sam) can erase core problems such as distrust of authority figures, poor education, promiscuity, drug addiction, and violence? The facts show no.
Are we to believe that the federal government is effective at public education? The facts show that the high school dropout rate has remained the same for 40 years, despite the fact that trillions of federal dollars were poured into education. We must support alternatives that offer parental options for educational opportunity. A good education leads to self-reliance and social responsibility. This in turn leads to a good job.
Are we to believe that Medicaid “leveled the playing field” for patients? The fact is that fewer and fewer physicians can take Medicaid due to payments below the cost of providing the services. Where is the “social justice” in a health care system where NO one has quality, individualized care?
We have to change Washington’s way of thinking from “if a social program fails, expand it” to “if it fails, dismantle it.” Today’s policies lead to unhealthy dependence on the federal government. We need instead to encourage independence and freedom. Everyone – at all income levels – suffer from these government-controlled programs because we have more fatherless and poorly-educated children.
Safety nets don’t cure poverty. Education and jobs cure poverty. Family and community are the institutions through which we should help each other. Voting for government bureaucracy is not a surrogate for personally giving our time. Community aid is not only direct, more efficient, and more effective, it is personal. Our personal relationships are crucial to maintaining our civil society.
We can’t let politicians use our differences as a wedge to divide. The rhetoric of class warfare fosters resentment and envy. Class warfare does not sow the seeds of success. Our free enterprise system and the free market of ideas have brought more prosperity and a higher standard of living to the greatest number of people, regardless of race or color.
A free market built on integrity should be protected. We cannot let it be destroyed by excessive entanglement of government with business and crony capitalism. We can use existing laws to weed out bad apples. We do not need suffocating regulations and government control for all.
Finally, we must protect one of the most intimate and life-sustaining bonds in our society: the patient-doctor relationship. Patients entrust their secrets to doctors. How comfortable does it make you feel to know that the National Coordinator of Health Information Technology is watching…or using your personal medical records against you?
Touching lives one at a time is why I became a doctor. Fighting for what’s best for patients is what I do as a physician. "
"I was born to be a physician. My grandfather was one of two black students in the 1911 graduating class of Starling Ohio Medical College. He dedicated his life to medicine and helping the low-income folks of Lima, Ohio. My father became an Army Air Force flight surgeon at Tuskegee. As a general practitioner in San Diego, he charged patients what they could afford.Many times we were paid in tamales.
Then came Medicaid. It prohibited doctors from being able to use charity like this. We had high hopes when The Great Society was born: the end of poverty, the end of racial strife. These poverty programs were good intentions gone awry. What social engineer devised a diabolical program forcing a mother in hardship to eject her children’s father from the house in order to get financial assistance? The road to hell began with this kind of “social justice.” Common sense tells me that families in trouble would derive strength from staying together.
The results of the disintegration of the family are fully evident. Unwed motherhood has almost tripled since the 1960s War on Poverty. Seventy-two per cent of Black and fifty-three per cent of Hispanic children are now born to single mothers. Single motherhood quadruples the chance of living in poverty.
Things have gotten worse, not better. Politicians are so arrogant they tell people to “Trust me!” based on faith, not facts. Are we to believe that it works to treat people like helpless victims? The fact is the poverty rate has not changed in 40 years. Are we to believe that a check from a distant rich Uncle (Sam) can erase core problems such as distrust of authority figures, poor education, promiscuity, drug addiction, and violence? The facts show no.
Are we to believe that the federal government is effective at public education? The facts show that the high school dropout rate has remained the same for 40 years, despite the fact that trillions of federal dollars were poured into education. We must support alternatives that offer parental options for educational opportunity. A good education leads to self-reliance and social responsibility. This in turn leads to a good job.
Are we to believe that Medicaid “leveled the playing field” for patients? The fact is that fewer and fewer physicians can take Medicaid due to payments below the cost of providing the services. Where is the “social justice” in a health care system where NO one has quality, individualized care?
We have to change Washington’s way of thinking from “if a social program fails, expand it” to “if it fails, dismantle it.” Today’s policies lead to unhealthy dependence on the federal government. We need instead to encourage independence and freedom. Everyone – at all income levels – suffer from these government-controlled programs because we have more fatherless and poorly-educated children.
Safety nets don’t cure poverty. Education and jobs cure poverty. Family and community are the institutions through which we should help each other. Voting for government bureaucracy is not a surrogate for personally giving our time. Community aid is not only direct, more efficient, and more effective, it is personal. Our personal relationships are crucial to maintaining our civil society.
We can’t let politicians use our differences as a wedge to divide. The rhetoric of class warfare fosters resentment and envy. Class warfare does not sow the seeds of success. Our free enterprise system and the free market of ideas have brought more prosperity and a higher standard of living to the greatest number of people, regardless of race or color.
A free market built on integrity should be protected. We cannot let it be destroyed by excessive entanglement of government with business and crony capitalism. We can use existing laws to weed out bad apples. We do not need suffocating regulations and government control for all.
Finally, we must protect one of the most intimate and life-sustaining bonds in our society: the patient-doctor relationship. Patients entrust their secrets to doctors. How comfortable does it make you feel to know that the National Coordinator of Health Information Technology is watching…or using your personal medical records against you?
Touching lives one at a time is why I became a doctor. Fighting for what’s best for patients is what I do as a physician. "
WOW. I don't live in California anymore but if I did, she'd get my vote.
Saturday, September 29, 2012
The BMI of the Chicago Teachers
Last week, when I was looking at the news and the Chicago Teachers' Union strike showed the teachers on parade, on strike, it was striking how THEY ARE ALL OBESE. Not just a little chunky, a little zaftig...OBESE.
The devil in me thinks that the marching maybe did their health some good. Certainly not for the children...they were babysat and fed as per the Board of Ed. rules regarding school lunches (and breakfasts). Has it gotten so horrible in America that kids have to go to school to be fed? If you have kids, don't you have the commitment to feed and clothe the child? Oh wait, silly me, such a concern is downright Victorian. FDR fixed it.
The devil in me thinks that the marching maybe did their health some good. Certainly not for the children...they were babysat and fed as per the Board of Ed. rules regarding school lunches (and breakfasts). Has it gotten so horrible in America that kids have to go to school to be fed? If you have kids, don't you have the commitment to feed and clothe the child? Oh wait, silly me, such a concern is downright Victorian. FDR fixed it.
Secret Shopper
One thing I really love to do is to be a patient and not say one word to anyone that I'm a physician. I want to see/feel/hear how regular patients are treated, and I don't want to be subjected to the hallway consults of dermatological issues that other patients in the office are having--and this has happened to me--once I was getting a physical and my doc asked me about a patients' rash in another room--I told him to have the patient call my office :-)
I went for a flu shot at a local walk in clinic. I perused their glossy brochures by the front desk. They have 3 MD's --older white men, medical school grads of the 70's--and 9 staff "ARNP" with so many letters after their names I was wondering if they wanted to print an alphabet soup. CSH, ARNP, MSM, WTF?? What is all of this crap?
Now, I do not for a minute minimize nor belittle what RNP's do. However, to have a walk-in medical clinic staffed with them nearly 3 to 1, something is wrong. I thought all RNP's had to be supervised and present each patient's case to a licensed physician. I don't know what the regs are currently and I don't care. I do know that the vast horde of America believes that a white coat=doctor. You could be a janitor, or excuse me, "maintenance specialist" and if you're wearing a white coat people will fall over themselves to get your attention and curry favor. This clinic is clearly ramming thru 3 times the volume of patients for each MD, because each MD is the one that bills insurance. I do know an ARNP cannot be free standing and bill Medicare directly, they must do it under a physician's license number. So the clinic "pumps and dumps". They conveniently have an on-site pharmacy, lab, and x-ray. All geared to squeezing the most out of each patient encounter.
I hate that.
So I was just a regular, Joe Schmo patient getting my flu shot. No questions, no inane comments about my chosen specialty, and no nervousness afoot. I sense that if they know I'm a doctor, they get nervous. I don't want nervousness, I just wanted to get the damned shot and get out. I was treated well and had no complaints about the whole show.
Unlike an a&^&*%e last year who called my office declaring he was doctor-such-and-such and he demanded to be seen. When I interviewed him, the guy had a PhD in biochemistry and worked for a pharmaceutical company his whole life. A**&&**&! You're not a doctor to me. HA!
I went for a flu shot at a local walk in clinic. I perused their glossy brochures by the front desk. They have 3 MD's --older white men, medical school grads of the 70's--and 9 staff "ARNP" with so many letters after their names I was wondering if they wanted to print an alphabet soup. CSH, ARNP, MSM, WTF?? What is all of this crap?
Now, I do not for a minute minimize nor belittle what RNP's do. However, to have a walk-in medical clinic staffed with them nearly 3 to 1, something is wrong. I thought all RNP's had to be supervised and present each patient's case to a licensed physician. I don't know what the regs are currently and I don't care. I do know that the vast horde of America believes that a white coat=doctor. You could be a janitor, or excuse me, "maintenance specialist" and if you're wearing a white coat people will fall over themselves to get your attention and curry favor. This clinic is clearly ramming thru 3 times the volume of patients for each MD, because each MD is the one that bills insurance. I do know an ARNP cannot be free standing and bill Medicare directly, they must do it under a physician's license number. So the clinic "pumps and dumps". They conveniently have an on-site pharmacy, lab, and x-ray. All geared to squeezing the most out of each patient encounter.
I hate that.
So I was just a regular, Joe Schmo patient getting my flu shot. No questions, no inane comments about my chosen specialty, and no nervousness afoot. I sense that if they know I'm a doctor, they get nervous. I don't want nervousness, I just wanted to get the damned shot and get out. I was treated well and had no complaints about the whole show.
Unlike an a&^&*%e last year who called my office declaring he was doctor-such-and-such and he demanded to be seen. When I interviewed him, the guy had a PhD in biochemistry and worked for a pharmaceutical company his whole life. A**&&**&! You're not a doctor to me. HA!
Tuesday, August 28, 2012
Remember kids, Safety First!
I rememder some slogan from my 1970's elementary school experience that went "Safety First" or something like it. My impressionable young mind retained this slogan till the present day. I look both ways when I cross a street, I wash my hands a zillion times a day, I'm hyper-aware of all the stimuli around me. It gets exhausting.
But now, to maintain my board certification (that's right, for those of us unlucky enough to be born in the 1960's and afterwards, we have time-limited board certification) I must take a "Patient Safety" online course. No matter that doctors practice in a myriad of ways, from concierge to hospital-only; the course is the same. What's worse, it's the same course for every kind of doctor, whether a psychiatrist, pathologist, or a trauma surgeon.
Now, the thing is, what this is TRULY about, is paying $25 (it's helpful that they take credit cards online) to an unheard-of entity to take a mind-numbing online course extolling to virtues of root cause analysis for medical errors.
Into this bag of responsibility also falls the fact that I am responsible for reminding or notifying a patient that he/she has a follow up appointment.
When was my career as a physician saddled with the task of appointment manager?
When you hurt, and you have a doctor's appointment, you keep the appointment in the thing known as a CALENDAR and now they even have them in smartphones and they go **ping** when you have an appointment....and I think it's fair to say that if you aren't even sufficiently invested to keep your appointment, how are you a good risk for me to take? How are you a compliat patient? How are you a patient that deserves my time and effort?
The simple fact is, you're none of the above. You're a flake that NEEDS to be discharged.
I'm not talking about people who are overscheduled, forget, and call us the next day full of apologies and excuses. I'm not talking about the people who had other crises erupt, or who had a death in the family, etc. and missed their appointment only to realize it days later. I'm willing to give those the benefit of the doubt. I am more than happy to reschedule anybody who apologizes and who WANTS to come in.
I'm referring to those who never call, never show up, and just fade off the planet. We've gotten onto the merry-go-round of phone calls to disconnected phone numbers, not-in-service cell phones, and I've just given up the excessive waste of time and energy that it takes to be an appointment babysitter.
Yet, in this Safety Course, it was harped on again and again. Why? I don't know. I understand that medication errors occur, chart errors occur, etc. but since when does a missed appointment fall under the purview of a physicians' duties as a safe practice?
Because it's an easy clerical task that can be called upon in a court of law. Nothing to do with actual medical delivery and medical duty.That's what I believe.
The Foundations in Patient Safety course was entirely geared towards hospital based medicine. That's where the big money, risk, and federal oversight is the heaviest.
My dentist informed me that they get annual recommendations from the ADA to discharge the bottom 10% of patients that are, in his words, dead weight. I always marvel at how dentists have managed to avoid being called health care (we all know that periodontal disease and abcesses are quite lethal) but they are completely outside of this system. Fascinating.
But now, to maintain my board certification (that's right, for those of us unlucky enough to be born in the 1960's and afterwards, we have time-limited board certification) I must take a "Patient Safety" online course. No matter that doctors practice in a myriad of ways, from concierge to hospital-only; the course is the same. What's worse, it's the same course for every kind of doctor, whether a psychiatrist, pathologist, or a trauma surgeon.
Now, the thing is, what this is TRULY about, is paying $25 (it's helpful that they take credit cards online) to an unheard-of entity to take a mind-numbing online course extolling to virtues of root cause analysis for medical errors.
Into this bag of responsibility also falls the fact that I am responsible for reminding or notifying a patient that he/she has a follow up appointment.
When was my career as a physician saddled with the task of appointment manager?
When you hurt, and you have a doctor's appointment, you keep the appointment in the thing known as a CALENDAR and now they even have them in smartphones and they go **ping** when you have an appointment....and I think it's fair to say that if you aren't even sufficiently invested to keep your appointment, how are you a good risk for me to take? How are you a compliat patient? How are you a patient that deserves my time and effort?
The simple fact is, you're none of the above. You're a flake that NEEDS to be discharged.
I'm not talking about people who are overscheduled, forget, and call us the next day full of apologies and excuses. I'm not talking about the people who had other crises erupt, or who had a death in the family, etc. and missed their appointment only to realize it days later. I'm willing to give those the benefit of the doubt. I am more than happy to reschedule anybody who apologizes and who WANTS to come in.
I'm referring to those who never call, never show up, and just fade off the planet. We've gotten onto the merry-go-round of phone calls to disconnected phone numbers, not-in-service cell phones, and I've just given up the excessive waste of time and energy that it takes to be an appointment babysitter.
Yet, in this Safety Course, it was harped on again and again. Why? I don't know. I understand that medication errors occur, chart errors occur, etc. but since when does a missed appointment fall under the purview of a physicians' duties as a safe practice?
Because it's an easy clerical task that can be called upon in a court of law. Nothing to do with actual medical delivery and medical duty.That's what I believe.
The Foundations in Patient Safety course was entirely geared towards hospital based medicine. That's where the big money, risk, and federal oversight is the heaviest.
My dentist informed me that they get annual recommendations from the ADA to discharge the bottom 10% of patients that are, in his words, dead weight. I always marvel at how dentists have managed to avoid being called health care (we all know that periodontal disease and abcesses are quite lethal) but they are completely outside of this system. Fascinating.
Tuesday, July 17, 2012
Tighten the screws
Increasing numbers of patients are calling about whether we'll participate with PPACA. WTF? I have no clue how the "program" will be administered. It hasn't been stated, anywhere, how the nuts and bolts of doctoring will work in the new system. Much hand wringing about insurance exchanges, Medicaid, and that "you can keep your doctor"....HAHHAHAHAHA! As what, your personal nursemaid? People won't be allowed to see doctors, that's my feeling. They'll be shunted to NP's and PA's first to do the triaging. One hospital CEO has been quoted in the WSJ as stating that the "volume" will more than make up for the decreased reimbursement. Just churn them thru, "doc" and shut up. Who knows how specialists will be handled. None of this has been made clear, not even a little bit.
It's not about health care. It's about health payment and taxation. You heard it here first.
It's not about health care. It's about health payment and taxation. You heard it here first.
Wednesday, June 27, 2012
"Just bear with me, one moment please..."
I was on the phone with various Humana agents for about 45 minutes, being ping-ponged from one to another. They do not have an HMO presence in my geographic locale but as a "provider" I may accept their Medicare Advantage/PPO members and bill the insurance company without any contracts. Or so they say. The current issue I am facing is that I am being treated as a primary care provider when in fact I am a specialist, a dermatologist. The copayments are different. I trained as a dermatologist and my claims need to be processed as such, not by a random high school dropout who sees my claim and does the automatic rote thing. I fight daily for such small humiliations to be removed from my hair.
For those of you who do not know, Medicare Advantage plans were all the rage in Florida as the new kid on the block about 4 years ago. They were "rushed like a fraternity in September" because they promised senior citizens zero out-of-pocket charges and they tossed in little goodies like gym membership discounts or prescription plans. In sum, seniors get Medicare premiums docked from their Social Security checks. Yes, that's right, what you "paid into" all those years as a working stiff is no longer enough, you must continue to pay for it even from your Social Security check. Then they are subject to a $140 calendar year deductible and 20% copayment of the allowed charge for all outpatient, or Part B, services.
When the retiree joins these Advantage plans, they no longer get the Medicare premium docked from their Social Security check. The Medicare Advantage plans get government grants, in a lump sum, to cover the senior citizen, and then they "deliver" services at a bundled rate. Part of that sum goes towards advertising and promotion, so government is funding non-medical activities in this method, by feeding a private sector entity. Patients pay a flat copay at office visits, somewhere between $15-50 depending on the plan they choose. Specific drugs, labs, etc must be used, and only doctors who accept the plan can be seen by the retiree. A doctor does not have to accept the plan even if they are a participating doctor with Medicare. There is a different fee schedule (LOWER OF COURSE) and more restrictions on types of services covered.
The controversy came in when fast talking salespeople came to town and offered seniors free coffee and donuts to get them to switch to their HMO-like system. You all know that people would sell their souls for a jelly donut. The insurance agents got huge commissions and bonuses for signing seniors up in bulk. The rude awakening came when plans over-promised and under-delivered. The infamous "Any Any Any Plan"-- literally that was the name of a certain Tampa-based plan-- got shut down by the feds for not paying doctors and hospitals and they went bankrupt. I refused to accept that plan many a time (simply because of their absurd name) and I faced harsh words from my patients who were on this, only to then hear their lamentations when the plan got busted. Sorry Charlie. If you yell at me I won't be your doctor.
In any event, I'll wait and see what happens with Humana. If they can't correct the glitch in their system that doesn't recognize what I do, I'll refuse to deal with them any further and drop it. I had long standing patients switch to their Advantage Plan and I took it and billed it, got paid within 14 days, and all was fine, until I read the fine print and saw they weren't able to code me as a specialist for mysterious reasons. We shall see if they will fix it. I'm not holding my breath.
Update on 10/15/2012: Not one letter, phone call, nor follow-up to this situation has occurred. They haven't done one thing. I'm tired of this BS so I'm dropping it. Stick a fork in me. I'm done.
For those of you who do not know, Medicare Advantage plans were all the rage in Florida as the new kid on the block about 4 years ago. They were "rushed like a fraternity in September" because they promised senior citizens zero out-of-pocket charges and they tossed in little goodies like gym membership discounts or prescription plans. In sum, seniors get Medicare premiums docked from their Social Security checks. Yes, that's right, what you "paid into" all those years as a working stiff is no longer enough, you must continue to pay for it even from your Social Security check. Then they are subject to a $140 calendar year deductible and 20% copayment of the allowed charge for all outpatient, or Part B, services.
When the retiree joins these Advantage plans, they no longer get the Medicare premium docked from their Social Security check. The Medicare Advantage plans get government grants, in a lump sum, to cover the senior citizen, and then they "deliver" services at a bundled rate. Part of that sum goes towards advertising and promotion, so government is funding non-medical activities in this method, by feeding a private sector entity. Patients pay a flat copay at office visits, somewhere between $15-50 depending on the plan they choose. Specific drugs, labs, etc must be used, and only doctors who accept the plan can be seen by the retiree. A doctor does not have to accept the plan even if they are a participating doctor with Medicare. There is a different fee schedule (LOWER OF COURSE) and more restrictions on types of services covered.
The controversy came in when fast talking salespeople came to town and offered seniors free coffee and donuts to get them to switch to their HMO-like system. You all know that people would sell their souls for a jelly donut. The insurance agents got huge commissions and bonuses for signing seniors up in bulk. The rude awakening came when plans over-promised and under-delivered. The infamous "Any Any Any Plan"-- literally that was the name of a certain Tampa-based plan-- got shut down by the feds for not paying doctors and hospitals and they went bankrupt. I refused to accept that plan many a time (simply because of their absurd name) and I faced harsh words from my patients who were on this, only to then hear their lamentations when the plan got busted. Sorry Charlie. If you yell at me I won't be your doctor.
In any event, I'll wait and see what happens with Humana. If they can't correct the glitch in their system that doesn't recognize what I do, I'll refuse to deal with them any further and drop it. I had long standing patients switch to their Advantage Plan and I took it and billed it, got paid within 14 days, and all was fine, until I read the fine print and saw they weren't able to code me as a specialist for mysterious reasons. We shall see if they will fix it. I'm not holding my breath.
Update on 10/15/2012: Not one letter, phone call, nor follow-up to this situation has occurred. They haven't done one thing. I'm tired of this BS so I'm dropping it. Stick a fork in me. I'm done.
Wednesday, June 20, 2012
First Day of Summer
Doctors are under assault by the patients, FDA, the Feds, CMS (OMG did I use the correct modifier? Am I going to jail?) and by insurance companies. This is all a given. What I'm finding more cheery is that doctors are repeatedly hitting back. The AMA no longer represents physicians, and there is open revolt going on with PPACA. Increasingly, physicians are acting in ways that would've shocked me 10 years ago. Examples abound, but not taking certain insurance plans, going concierge/cash only, and going to work for industry are increasing examples of why we're seeing more doctor shortages than ever before. It's not that there are less doctors, but there are less PRACTICING doctors. Doctors have multiple talents and lots of corporate entities find that the background intelligence and training that doctors can bring to the table leads to a distinct edge in being placed on corporate boards and such.
Anyway, it's the first day of summer! YES! Plans for trips are swirling. Here are my current three obsessions this month:
1. Whole Foods' Mixed Berry Cereal Bars. Nutritious, not full of unpronounceable toxic shmutz, and yummy.
2. Palomar Starlux Laser Corp. has provided zero friendliness after purchase, but I must say their customer service and ordering dept. is excellent. THANK YOU, you know who you are.
3. Arnica is really great for muscle soreness. You can get it at health food stores, Whole Foods, etc.
Anyway, it's the first day of summer! YES! Plans for trips are swirling. Here are my current three obsessions this month:
1. Whole Foods' Mixed Berry Cereal Bars. Nutritious, not full of unpronounceable toxic shmutz, and yummy.
2. Palomar Starlux Laser Corp. has provided zero friendliness after purchase, but I must say their customer service and ordering dept. is excellent. THANK YOU, you know who you are.
3. Arnica is really great for muscle soreness. You can get it at health food stores, Whole Foods, etc.
Monday, June 4, 2012
Let me just opt out. No Mail.
Today I went to check my mail at the medical center, where my office is located, and I found a big bunch of mail held with a rubber band, bundled in the mailbox in the driveway of the Urgent Care. On top, a handwritten note (on the same yellow/orange notepaper used to claim certified receipt notices) dated 5/31 stated that "the mail will be withheld until the mailbox is moved". I received no mail on June 1, 2, or 4th, until the situation was discovered.
I notified the "medical center operations manager" --really a data-inputting grunt--and thus the bureaucratic dance began.
The new mail carrier had a battle going on with the medical center staff. She refused to drive her vehicle into the driveway and wanted the mailbox moved to the "regulation of 3 inches within the curb" because in Florida, postal carriers do not walk out of their vehicles, they sit in the truck and deliver mail into mailboxes at the edges of the curbs. This is why they are all obese and full of varicosities and Type II diabetes. I know this because I treat some of them, as patients. Oh and you, dear taxpayer, are paying for the most Cadillac-of-Cadillac-health plans to treat and correct these medical conditions, directly caused by the sedentary and molly-coddled lifestyle these persons lead.
The medical center manager went to talk to the postmaster. He was completely unaware of the withheld mail edict, apologized, and stated all mail would resume tomorrow.
I am TOTALLY concerned about the fact that a mail carrier unilaterally decided to withhold my mail, along with the mail of the entire complex, in effect, holding it hostage. They have done this from time immemorial. Postal carriers steal mail, brightly colored birthday cards, welfare checks, you name it. They are underpaid grunts who can't be fired, handling our really sensitive documents, and it's enshrined in the Constitution. Sometimes they "go postal" and start shaking and shooting or opening Pepsi bottles in WalMart aisles. And they wonder why they're going bankrupt. Any possible way that I can avert having to deal with the USPS, I follow. E-payments? Check. Email? Check. Electronic pathology reports? Check. Bloodwork results faxed? Check.
But not everything can be handled electronically. The world is straddling the paper and the internet systems right now, and we have medical records coming in from Dr. Smith in Sheboygan, on paper. Mrs. Hunt sends in her copayment via handwritten check, via US Mail. And so forth.
I am a physician trying to run a medical practice. I have bills, reports, payments, and sensitive mail that is coming to my attention, such as lab tests, pathology records, etc. This is clearly unacceptable behavior and crosses the ethical boundary of the mail carrier. What assurance do I have that no mail was comprised? How do I know if something was stolen, or lost, in this process? I need answers.
Medicare has ruled that as a participating physician, I must have a physical address for mail, no P.O.Boxes are accepted. So that avenue is cut off.
Can't I have what Kramer in "Seinfeld" wanted all those years ago, to "opt out" of mail? Seriously, why can't we just opt out? We can show an ID and pick up all the mail at a given post office. That's it. No carriers, no delivery.
I will dance, sing, pour vodka over my head, turn cartwheels, and let fly all sorts of fireworks when two things happen. First, the USPS goes bankrupt and Congress overturns its monopolistic hold on First Class Mail. And second, Obama loses the election. Homer Simpson could be sworn in, and I'd be delirious. I just can't take the Stalinist "Forward" motto. It calls to mind "Pa'lante" (Castro) "Forward" (Mao and Stalin).
http://www.theblaze.com/stories/forward-for-communism-is-obamas-new-forward-slogan-really-a-coincidence/
Monday, May 28, 2012
Long hiatus
Been away for a while, I got very sick. Bronchitis, sinusitis, otitis, and finally, bilateral conjunctivitis to wrap it all up. I was a mess, seeing multiple doctors, taking time off from work and everything else, numerous antibiotics and prednisone. Not fun, felt so powerless. If anything, it strengthened my compassion for the sick, and made me take stock of the horror of my work treadmill. SO I stopped accepting new patients, cut my schedule down drastically. Took some time off.
I'm much better for it.
Thanks to my husband for giving me a butt kick and forcing me to stay still and to rest, being supportive all the way. We recently celebrated our 10th anniversary and went away somewhere quiet and beautiful.
It's Memorial Day. While I appreciate the day off and the "start of summer" moniker, I always think of the vets I treated, their stories, their humility and sense of humor, when I worked at various VA hospitals. They are true American heroes, I respect them with all of my heart.
It saddens me so much when I hear of deaths of our service men and women in the combat theaters around the world. What a giant waste. I don't need perpetual reminding of the waste of war. We need to use more diplomacy, and we need to leave the heathens to themselves more often than not. We give them money and weapons and then they turn it on us, 9/11. We're not going to "fix" Iraq/Afghanistan/Iran/Syria whatever...I am so tired of the constant warring. Just think for a minute of our people in their prime who have been destroyed by war.
I'm much better for it.
Thanks to my husband for giving me a butt kick and forcing me to stay still and to rest, being supportive all the way. We recently celebrated our 10th anniversary and went away somewhere quiet and beautiful.
It's Memorial Day. While I appreciate the day off and the "start of summer" moniker, I always think of the vets I treated, their stories, their humility and sense of humor, when I worked at various VA hospitals. They are true American heroes, I respect them with all of my heart.
It saddens me so much when I hear of deaths of our service men and women in the combat theaters around the world. What a giant waste. I don't need perpetual reminding of the waste of war. We need to use more diplomacy, and we need to leave the heathens to themselves more often than not. We give them money and weapons and then they turn it on us, 9/11. We're not going to "fix" Iraq/Afghanistan/Iran/Syria whatever...I am so tired of the constant warring. Just think for a minute of our people in their prime who have been destroyed by war.
Tuesday, February 28, 2012
wow all insurance kinda sucks
I love it when I'm held to the highest, most stringent standard possible, but everybody else can do whatever, whenever, why-ever. And nothing happens to them. There are no consequences for the rest of the world for a big general f*** up, but for the doctors, NOOOOOOOOOOO. Hellfire and brimstone will come your way, doc! Make sure the HIPAA 5010 data box doesn't include a PO BOX in your address or you won't get paid. I'm not making this up. (see letter below from MGMA to Kathleen Sebelius regarding the 5010 f*** up).
Department of Health and Human Services
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, DC 20201
Dear Secretary Sebelius:
The Medical Group Management Association (MGMA) requests that you take immediate
action to address the payment disruption issues that have occurred as a result of the federally
mandated transition to HIPAA Version 5010 electronic transactions on Jan. 1. Medical
practices throughout the nation are experiencing significant challenges implementing these
new transactions, a situation that has led to considerable cash flow problems for physicians
and their practices. Problems are being reported with both Medicare Administrative
Contractors (MACs) and commercial plans.
Should the government not take the necessary steps, many practices face significantly
delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or
even the prospect of closing their practice. As the transition to Version 5010 is a mandatory
step toward ICD-10 implementation, this raises even more concerns, understanding the
magnitude of ICD-10 is exponentially greater than Version 5010.
MGMA-ACMPE is the premier association for professional administrators and leaders of
medical group practices. Since 1926, the Association has delivered networking, professional
education and resources, political advocacy and certification for medical practice
professionals. The Association represents 22,500 members who lead 13,200 organizations
nationwide in which some 280,000 physicians provide more than 40 percent of the healthcare
services delivered in the United States.
Version 5010 Issues and Concerns
Physician practices have reported numerous problems across various areas of the United
States stemming from the transition to Version 5010. The most frequently reported problems
have involved:
Issues with practice management and/or billing systems that showed no problems
during the testing phase with their MAC, but once the practice moved into production
phase, found their claims being rejected
Issues with secondary payers
Rejections due to various address issues (pay-to address being stripped/lost from
claims; pay to address can no longer be the same as billing address; no PO Box
address)
Crosswalk NPI numbers not being recognize
Apart from the atrocious grammar and numerous typos, my spirit is simpatico to this letter and I agree the whole thing needs serious pushing back.
My business insurance policy wanted to have some outsourced guy come to the office to photograph the contents, and probably make sure I'm not some fraudulent business. Ok, fine. But this individual failed to show up at the appointed hour, and when called to check on why HE no-showed, some vague ministrations about a long day and so forth were made. We called again and left a message, nobody to actually speak to. This was 2 weeks ago. Today I get a letter from the insurance company that since I "refused" the mandatory inspection my policy would be cancelled. Holy hell!
My agent was sweating bullets and I let him have it. He will have to actually work for a living and attempt to correct this huge mistake. If this is how they do business, the policy will be cancelled. There is competition, still, God bless 'em.
I think there are so many things that have gone awry in the insurance industry that it's beyond repair. The norm is fraud. Therefore, they're on high alert and double check every tiny detail, even my tiny little office in a medical building.
Who knows where this poor outsourced shmo is. He probably quit and there's nobody else who will do this grunt work for minimum wage. Whatever.
Department of Health and Human Services
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, DC 20201
Dear Secretary Sebelius:
The Medical Group Management Association (MGMA) requests that you take immediate
action to address the payment disruption issues that have occurred as a result of the federally
mandated transition to HIPAA Version 5010 electronic transactions on Jan. 1. Medical
practices throughout the nation are experiencing significant challenges implementing these
new transactions, a situation that has led to considerable cash flow problems for physicians
and their practices. Problems are being reported with both Medicare Administrative
Contractors (MACs) and commercial plans.
Should the government not take the necessary steps, many practices face significantly
delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or
even the prospect of closing their practice. As the transition to Version 5010 is a mandatory
step toward ICD-10 implementation, this raises even more concerns, understanding the
magnitude of ICD-10 is exponentially greater than Version 5010.
MGMA-ACMPE is the premier association for professional administrators and leaders of
medical group practices. Since 1926, the Association has delivered networking, professional
education and resources, political advocacy and certification for medical practice
professionals. The Association represents 22,500 members who lead 13,200 organizations
nationwide in which some 280,000 physicians provide more than 40 percent of the healthcare
services delivered in the United States.
Version 5010 Issues and Concerns
Physician practices have reported numerous problems across various areas of the United
States stemming from the transition to Version 5010. The most frequently reported problems
have involved:
Issues with practice management and/or billing systems that showed no problems
during the testing phase with their MAC, but once the practice moved into production
phase, found their claims being rejected
Issues with secondary payers
Rejections due to various address issues (pay-to address being stripped/lost from
claims; pay to address can no longer be the same as billing address; no PO Box
address)
Crosswalk NPI numbers not being recognize
Apart from the atrocious grammar and numerous typos, my spirit is simpatico to this letter and I agree the whole thing needs serious pushing back.
My business insurance policy wanted to have some outsourced guy come to the office to photograph the contents, and probably make sure I'm not some fraudulent business. Ok, fine. But this individual failed to show up at the appointed hour, and when called to check on why HE no-showed, some vague ministrations about a long day and so forth were made. We called again and left a message, nobody to actually speak to. This was 2 weeks ago. Today I get a letter from the insurance company that since I "refused" the mandatory inspection my policy would be cancelled. Holy hell!
My agent was sweating bullets and I let him have it. He will have to actually work for a living and attempt to correct this huge mistake. If this is how they do business, the policy will be cancelled. There is competition, still, God bless 'em.
I think there are so many things that have gone awry in the insurance industry that it's beyond repair. The norm is fraud. Therefore, they're on high alert and double check every tiny detail, even my tiny little office in a medical building.
Who knows where this poor outsourced shmo is. He probably quit and there's nobody else who will do this grunt work for minimum wage. Whatever.
Wednesday, February 15, 2012
Lead in lipstick
"Lead in lipstick!!" screams the headline, and in come the panicked patients....
The public needs to know that the lead is not an added ingredient in the lipsticks. Lead is a natural element that gets measured by the fact that it is present in the dyes used in cosmetics. These dyes are elements, and the lead is a contaminant in these inert powders that are used to confer color. That is why generally speaking, the sheerer the lipstick, the lower the lead level.
Ever read the ingredient lists? "FD&C red #7", "iron oxide #4" "aluminum lakes #8" and the like, are derived specifically for the FDA and no cosmetic in the US can be sold without these specific dyes, which have been vetted by the FDA and they continue to be. These dyes often have aluminum too, and though I'm not a chemist, the way I understand it is that these metals impart color fastness and stability, so the red lipstick will remain a red lipstick.
Lead has a very long and ancient history as a cosmetic dye because it makes the pigment more stable. Queen Elizabeth I wore a lead based facial paint to cover up bad facial smallpox scars. Supposedly she also suffered from lead poisoning along with untold others.
Currently lead poisoning affects children the most because their growing systems can't handle exposure to this substance, and the old flaky paint used before 1975 ( I think) shed lead particles nto the air. The lead dust can be inhaled and cause lead toxicity. But that's a whole other story.
In the past century there have been no cases of lead poisoning from a cosmetic in the US. In fact, pigment is what gives lipsticks their variable inherent SPF level. It has been shown that women have much lower rates of cancer of the lip vs. men because women tend to cover their lips with lipstick, and though not formally rated, the zinc oxides and pigment bases provide some level of ultraviolet protection. Lead is well known as a UV and radiation blocker, which is why you get a lead apron draped over you when you get Xrays at the dentist :-)
There are many flaws in the FDA's logic, namely that lipstick isn't a "food". They are lumping the lead risks from lipsticks together with the lead risk from other cosmetics, no other cosmetic gets ingested, only lipstick. Eileen, to answer your question, I believe the FDA has set the safe threshold for lead in a color additive at 20 parts per million, similarly Canada and the EU. All of these lipsticks tested on their list fall below 5 parts per million.
To conclude this long rant, knowledge is power. Nothing is perfectly safe in this world. Don't take anybody's word for it. You must educate yourself and form your own opinions about what you're willing to use and not use. It's your body.
However, if we wanted to be perfectly natural we'd wear zero makeup. But where's the fun in that?
The public needs to know that the lead is not an added ingredient in the lipsticks. Lead is a natural element that gets measured by the fact that it is present in the dyes used in cosmetics. These dyes are elements, and the lead is a contaminant in these inert powders that are used to confer color. That is why generally speaking, the sheerer the lipstick, the lower the lead level.
Ever read the ingredient lists? "FD&C red #7", "iron oxide #4" "aluminum lakes #8" and the like, are derived specifically for the FDA and no cosmetic in the US can be sold without these specific dyes, which have been vetted by the FDA and they continue to be. These dyes often have aluminum too, and though I'm not a chemist, the way I understand it is that these metals impart color fastness and stability, so the red lipstick will remain a red lipstick.
Lead has a very long and ancient history as a cosmetic dye because it makes the pigment more stable. Queen Elizabeth I wore a lead based facial paint to cover up bad facial smallpox scars. Supposedly she also suffered from lead poisoning along with untold others.
Currently lead poisoning affects children the most because their growing systems can't handle exposure to this substance, and the old flaky paint used before 1975 ( I think) shed lead particles nto the air. The lead dust can be inhaled and cause lead toxicity. But that's a whole other story.
In the past century there have been no cases of lead poisoning from a cosmetic in the US. In fact, pigment is what gives lipsticks their variable inherent SPF level. It has been shown that women have much lower rates of cancer of the lip vs. men because women tend to cover their lips with lipstick, and though not formally rated, the zinc oxides and pigment bases provide some level of ultraviolet protection. Lead is well known as a UV and radiation blocker, which is why you get a lead apron draped over you when you get Xrays at the dentist :-)
There are many flaws in the FDA's logic, namely that lipstick isn't a "food". They are lumping the lead risks from lipsticks together with the lead risk from other cosmetics, no other cosmetic gets ingested, only lipstick. Eileen, to answer your question, I believe the FDA has set the safe threshold for lead in a color additive at 20 parts per million, similarly Canada and the EU. All of these lipsticks tested on their list fall below 5 parts per million.
To conclude this long rant, knowledge is power. Nothing is perfectly safe in this world. Don't take anybody's word for it. You must educate yourself and form your own opinions about what you're willing to use and not use. It's your body.
However, if we wanted to be perfectly natural we'd wear zero makeup. But where's the fun in that?
Monday, February 13, 2012
Musings on happenings
A cold front came in yesterday and it's been in the 50's today, which is cold in FL. When the northeast gets a cold front it often pushes cold stuff all the way down.....Weird.
Every year I get bioterrorism training, the anthrax thing was diagnosed by dermatologists in New York City, people had sores on their hands and faces that weren't healing, they didn't go to the ER when they had just the cutaneous anthrax. The poor people who inhaled the spores and got sick right away obviously were in ER's first but nobody knew what they had until 3-5 days later when the cultures came back. So every derm conference is super pro active about the skin manifestations of every single bioterrorism agent, from nuclear skin burns to smallpox to anthrax to bubonic plague, which was used against Genoa in the 14th century as a bioterror weapon by flinging dead infected corpses over the city walls by the invaders du jour. I thought you'd like that tidbit.
There was a fantastic dermatologist speaker, the deputy surgeon general, Dr. Boris Lushniak. He had to go investigate the monkeypox epidemic in 2003 from people importing prairie dogs as pets. He showed up at this little rural clinic in Indiana in his full CDC protective headgear and full body white jumpsuit because they didn't know what they were dealing with, and he says,"you can imagine how big everybody's eyes got when I show up in my regalia and say 'now don't worry, you're fine, I'm from the government and I'm here to help' " and the whole audience roared in laughter just imagining this. Monkeypox turns out to be a fairly benign thing, not lethal, but when he was sent by the CDC they were thinking it was potential smallpox. The fear and panic such a thing would cause is unimaginable. I always pray that this never comes to pass again. The military gets vaccinated against smallpox as soon as they are deployed. Civilians still are not. We were vaccinated in the 70's and it turns out that it still confers some level of immunity but not the best. The gov't is stockpiling vaccines still, they aren't commercially available. The anthrax vaccine performs very poorly, you need so many booster shots to get immunity, most people would balk. He said only those high risk military get vaccinated, I presume the ones sent to Afghanistan, where it is endemic from sheep and goats. Needless to say I had so much food for thought, like I do after every derm meeting, it is a ton of info to process!
Tuesday, February 7, 2012
acne being shifted to cosmetic
Acne vulgaris is a terrible condition for teens--or anybody--to deal with. It's visible to all and afflicts many with shame, humiliation, low self esteem and confidence, etc. One of the mainstays of treatment has been benzoyl peroxide, which for decades has been proven safe and useful in controlling the pustules and papules. A big drawback is the irritation it causes, and one formulation in particular, Brevoxyl made by Stiefel Pharma, has been around since I was a resident. It had a micro-encapsulated delivery where the molecule would preferentially get into the pores and not sit on the surface of the skin leading to redness and irritation. I don't have a lab and can't attest to the biochemistry involved, but clinically speaking, it was wonderful and worked great.
A casualty of the current recession is Brevoxyl. Stiefel sold "the name" to another pharmaceutical company, apparently because it went off patent, so the product is still called Brevoxyl, but the teenagers I'm seeing have terrible flare-ups and complain that they're getting irritation and redness that they weren't before. One bright kid brought in the current Brevoxyl "kit" and pointed out that the stripes on the box are different colors and the wash runs out of the bottle like water instead of like a creamy lotion as it did before. SO-- the patients know that something is up.
I did a little sleuthing and Brevoxyl as we knew it in the past is no more. It's basically now a generic. Savvy money-hungry pharmacists are refusing to fill renewals and prescriptions and simply directing the patients to Aisle 4 where the Clearasil is located. Uh, hello, are you the doctor? Do you know what this person has and how to treat it? Do you know if the person is intolerant of Clearasil? It's absolutely appalling. Patients have been abandoned by their medication, it is simply no longer available. "Too bad, you figure it out" is the attitude.Mothers are calling me in tears.
I have heard of this happening in other fields--certain chemotherapies where the manufacturers simply ceased operations, some FDA half-hearted investigations happened, with no conclusions. I cannot imagine the hell those patients and their oncologists have been put through.
Turns out Panoxyl is the new benzoyl peroxide OTC made by Stiefel but no "wholesaler" will get it for the patients because of order minimums and that's right, it's now OTC. Patients can order it from amazon.com or drugstore.com. if they so choose.
But for the most part, now it's back to the drawing board for many patients. The nice balance they achieved and the good control has been upset. They're red, irritated, and pimply. They need to be come in, be examined by me and we need to start at square one and get them on different therapy to manage their acne.
A casualty of the current recession is Brevoxyl. Stiefel sold "the name" to another pharmaceutical company, apparently because it went off patent, so the product is still called Brevoxyl, but the teenagers I'm seeing have terrible flare-ups and complain that they're getting irritation and redness that they weren't before. One bright kid brought in the current Brevoxyl "kit" and pointed out that the stripes on the box are different colors and the wash runs out of the bottle like water instead of like a creamy lotion as it did before. SO-- the patients know that something is up.
I did a little sleuthing and Brevoxyl as we knew it in the past is no more. It's basically now a generic. Savvy money-hungry pharmacists are refusing to fill renewals and prescriptions and simply directing the patients to Aisle 4 where the Clearasil is located. Uh, hello, are you the doctor? Do you know what this person has and how to treat it? Do you know if the person is intolerant of Clearasil? It's absolutely appalling. Patients have been abandoned by their medication, it is simply no longer available. "Too bad, you figure it out" is the attitude.Mothers are calling me in tears.
I have heard of this happening in other fields--certain chemotherapies where the manufacturers simply ceased operations, some FDA half-hearted investigations happened, with no conclusions. I cannot imagine the hell those patients and their oncologists have been put through.
Turns out Panoxyl is the new benzoyl peroxide OTC made by Stiefel but no "wholesaler" will get it for the patients because of order minimums and that's right, it's now OTC. Patients can order it from amazon.com or drugstore.com. if they so choose.
But for the most part, now it's back to the drawing board for many patients. The nice balance they achieved and the good control has been upset. They're red, irritated, and pimply. They need to be come in, be examined by me and we need to start at square one and get them on different therapy to manage their acne.
Wednesday, January 25, 2012
dry winter skin
Despite the fact that my profession has me spouting off the wonders of regular emolliation of the skin, I often neglect my own needs until it's crunch time. My skin was alligator-like on my legs, rough and peeling on my fingertips from repeated hand washing with industrial strength antibacterials. I followed my own advice and have been using Cetaphil cleanser in the shower, Cetaphil cream frequently on my hands and Cetaphil cream after my shower. Amazing changes, the dry flaking itchy skin is a heck of a lot better. The stuff is wonderful and I'm glad it hasn't changed in decades. Please keep it this way, Galderma Inc.!!!!
I'm not an insurance agent
The new year, new horizons, new challenges...and a new year for pateints' copayments, deductibles, and calendar year activity. This is an especially painful time. Patients don't know what their plans cover. They don't know what they're paying for. I blame the agents and the plans themselves, for perhaps providing information, but not providing understanding. Patients also have the ostrich-head-in-the-sand attitude, they don't want to know anything until they get a bill, then they start screaming. Literally. I am the face and the bricks-and-mortar location where they can walk in and scream. One lady looked like she was going to burst a blood vessel in my waiting room she was THAT agitated. Um, your plan didn't pay anything because you have to spend $5000 first before it kicks in. There are 800-numbers on the backs of their cards but the patients do not call and verify anything. Their agents sit back and demand payment for the policy and they can't (won't) answer any questions about the products they sell. They refer them to the 800 numbers on the back of the insurance card!
I am SO BEYOND FED UP. I am not an insurance agent, adjuster, nor processor. I do not magically know what your policy will and won't cover. I resent SO MUCH being in the middle of this tug of war and being attacked for doing my job. We have now started charging a nominal fee for doing "prior authorizations".
What is a prior authorization? Well, firstly it is a complete misnomer. It sounds like it would be something you do prior to seeing the patient to authorize some service. Nope. It is an ex post facto thing that I, the "prescriber" must do when the pharmacy calls me and states that Mr. Smith's drug is not being paid for by his insurance plan. I then need to speak to someone at Mr. Smiths' pharmacy benefit office, someone normally with a minimum of a high school education, who then screens my call and a staff pharmacist will then call me back. A day or two later, the pharmacist FROM THE INSURANCE COMPANY will interview me as to why Mr. Smith needs this drug. My doctors' degree, NPI, DEA, state license, etc are not sufficient to ensure that I know what I'm doing. This all a delay tactic to NOT pay for Mr. Smith's drug. I then have to fax the records and letters to get the insurance company to pay for the drug. After all this, they usually deny it and the patient must foot the bill. Meanwhile I have spent hours with this back-and-forth and my staff has spent untold time on this issue for which we are not being paid.
A bank charges $40 for a bounced check. Medical offices need to charge for employee and staff time, faxes and the toner, paper, etc. in dealing with essentially a negotiation to try to get a drug paid for a patient. This has gone beyond the pale. I am being continually harassed by all the above involved parties--patients, pharmacies (why do they care where the money comes from, whether it's the insurance plan or the patient? aaah vested interests mesh tightly....), and insurance plans to do this thing where, as far as I am concerned, my responsibility has been vacated. I interviewed, examined, and diagnosed the patient. I discussed treatment options and recommended a plan for the patient's disease. This continual snowball of responsibility has not been curtailed by the physicians' representatives/lobbies, the AMA has done the most piss-poor job on the planet of voicing the concerns and issues of the physicians. All they care about is selling the new ICD-10 coding book.
I am SO BEYOND FED UP. I am not an insurance agent, adjuster, nor processor. I do not magically know what your policy will and won't cover. I resent SO MUCH being in the middle of this tug of war and being attacked for doing my job. We have now started charging a nominal fee for doing "prior authorizations".
What is a prior authorization? Well, firstly it is a complete misnomer. It sounds like it would be something you do prior to seeing the patient to authorize some service. Nope. It is an ex post facto thing that I, the "prescriber" must do when the pharmacy calls me and states that Mr. Smith's drug is not being paid for by his insurance plan. I then need to speak to someone at Mr. Smiths' pharmacy benefit office, someone normally with a minimum of a high school education, who then screens my call and a staff pharmacist will then call me back. A day or two later, the pharmacist FROM THE INSURANCE COMPANY will interview me as to why Mr. Smith needs this drug. My doctors' degree, NPI, DEA, state license, etc are not sufficient to ensure that I know what I'm doing. This all a delay tactic to NOT pay for Mr. Smith's drug. I then have to fax the records and letters to get the insurance company to pay for the drug. After all this, they usually deny it and the patient must foot the bill. Meanwhile I have spent hours with this back-and-forth and my staff has spent untold time on this issue for which we are not being paid.
A bank charges $40 for a bounced check. Medical offices need to charge for employee and staff time, faxes and the toner, paper, etc. in dealing with essentially a negotiation to try to get a drug paid for a patient. This has gone beyond the pale. I am being continually harassed by all the above involved parties--patients, pharmacies (why do they care where the money comes from, whether it's the insurance plan or the patient? aaah vested interests mesh tightly....), and insurance plans to do this thing where, as far as I am concerned, my responsibility has been vacated. I interviewed, examined, and diagnosed the patient. I discussed treatment options and recommended a plan for the patient's disease. This continual snowball of responsibility has not been curtailed by the physicians' representatives/lobbies, the AMA has done the most piss-poor job on the planet of voicing the concerns and issues of the physicians. All they care about is selling the new ICD-10 coding book.
Monday, January 23, 2012
doctor doctor
A patient identified himself as a doctor to me, the front desk, the appointment manager, etc. Everybody knew he was a "doctor" before he even set foot in the office. Today when I asked him what kind of doctor, he said he's a biochemist with a PhD. Now that may be true, but it's irrelevant and a ploy to pull rank. I find that MD's never identify themselves as such. The ones who try to pull rank are the ones without rank.
Sunday, January 15, 2012
Disenfranchised
I was recently urged to join the AMA because it's the only organization that represents and battles for doctors' issues. Wrong-o. And that they've helped in getting certain things into PPACA. Wrong-o again. I have learned that the AMA secured many under-the-table promises that were denied later or flat out ignored. If you make a bargain with the Devil don't be shocked when he fails to keep his end. I just cannot relate to wanting to be part of a huge neo-fascist organization that revels in its bureaucracy and dogma. I'd rather go for a walk.
Why was I receiving nearly weekly letters in the mail to buy auto insurance through the AMA? Or more billing/coding manuals? Or phone calls from their sales dept. pushing the latest book---I got fed up long ago. Now I just view that organization the same way I view the cast of "Jersey Shore"--with benign amusement tempered by the taste of bile rising in my throat.
The recent sinking of that Italian cruiser reminded me that oftentimes, forced enjoyment may bring forced pain. I would rather read a quiet book on my recliner with my polarfleece throw and a cup of Earl Grey than be on a cruise ship anywhere in January. When asked where I go on vacation, I often say, where the people aren't. I love New York, Rome, Madrid, etc. but when I need to relax and recharge I go to the places where nobody ever goes or writes about. Of course I wouldn't divulge my secrets because then they wouldn't be secret anymore, right :-)???
Why was I receiving nearly weekly letters in the mail to buy auto insurance through the AMA? Or more billing/coding manuals? Or phone calls from their sales dept. pushing the latest book---I got fed up long ago. Now I just view that organization the same way I view the cast of "Jersey Shore"--with benign amusement tempered by the taste of bile rising in my throat.
The recent sinking of that Italian cruiser reminded me that oftentimes, forced enjoyment may bring forced pain. I would rather read a quiet book on my recliner with my polarfleece throw and a cup of Earl Grey than be on a cruise ship anywhere in January. When asked where I go on vacation, I often say, where the people aren't. I love New York, Rome, Madrid, etc. but when I need to relax and recharge I go to the places where nobody ever goes or writes about. Of course I wouldn't divulge my secrets because then they wouldn't be secret anymore, right :-)???
Wednesday, January 11, 2012
Get measured for a bra
There is something I keep seeing over and over in women of all ages. They continue to wear the same bras from years past, and while that doesn't sound like such a crime, it is when considering the inexorable effects of gravity, weight gain or loss, posture changes with osteoporosis, etc. Brassieres are made to hold up that which nature hath giveth....and nylon, cotton, spandex, polyester, etc. cannot go against Newton's postulates after the fibers have been frayed from washing machines and dryers. The problem comes when such ill-fitting bras lead to digging and tugging at the skin, which tends to accumulate sweat in the folds, and then yeast infections, generic redness/irritation, "intertrigo" (latin for "wheat in between"--yuck) and all sorts of nasties arise. No matter what drugs/powders/lotions/potions are prescribed, the problem recurs. The root of the problem is an ill fitting bra.
Getting fitted periodically for a bra is a good idea. Cup and band measurements fluctuate throughout a woman's lifetime. Most women just continually buy the same bra size they had at age 19. A properly fitting bra will not only be more comfortable, it will also relieve skin chafing and lead to happiness all around. I know Nordstrom's and Dillard's always has a bra specialist in their Lingerie departments, and Soma makes a big point of offering to measure you whenever you even walk in. So there you have it. Shop!!
Getting fitted periodically for a bra is a good idea. Cup and band measurements fluctuate throughout a woman's lifetime. Most women just continually buy the same bra size they had at age 19. A properly fitting bra will not only be more comfortable, it will also relieve skin chafing and lead to happiness all around. I know Nordstrom's and Dillard's always has a bra specialist in their Lingerie departments, and Soma makes a big point of offering to measure you whenever you even walk in. So there you have it. Shop!!
Tuesday, January 10, 2012
Tuesday's child
The disease keeps ramping up, and the patients' stress level keeps increasing. So much is uncertain and the populace is scared, nervous, uptight. I really do empathize with my patients, for whatever tumor/rash/abscess they happen to be suffering from. A lady came in today with a retained suture from last month. It happens, I've had it happen personally. The epidermis grows a little too fast and the suture gets trapped beneath it.
ANd oh, 10 days into the new year, Medicare has gotten the notice that it's 2012 and finally posted the new fee schedule. I cannot imagine how thousands of billing offices are automatically 10 days behind on the new year if they've had patients on new years day, the federal holiday, etc. For me it's just a about 3 dozen codes. For multiple doc practices it's hundreds. What a giant hemorrhoid to deal with.
In some uplifting news, the falcons and herons are moving through to their winter hunting and breeding grounds and it's a treat to see.
http://www.allaboutbirds.org/guide/Peregrine_Falcon/id/ac
My new favorite artist is Questlove (?uestlove) not sure how he spells it but I love his vibe.
ANd oh, 10 days into the new year, Medicare has gotten the notice that it's 2012 and finally posted the new fee schedule. I cannot imagine how thousands of billing offices are automatically 10 days behind on the new year if they've had patients on new years day, the federal holiday, etc. For me it's just a about 3 dozen codes. For multiple doc practices it's hundreds. What a giant hemorrhoid to deal with.
In some uplifting news, the falcons and herons are moving through to their winter hunting and breeding grounds and it's a treat to see.
http://www.allaboutbirds.org/guide/Peregrine_Falcon/id/ac
My new favorite artist is Questlove (?uestlove) not sure how he spells it but I love his vibe.
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