Adventures in Medical Business

More turmoil, more bad news. I heard from an elderly patient --who had stage IV bladder cancer and seemingly has a permanent foley catheter--that his urologists were all "leaving town". He told me there was an article in the local newspaper last week stating that that Specialists in Urology --a big beautiful practice with a big, beautiful, glossy-white art-deco building, and 7 urologists--is scheduled to close in March 2017. I was alarmed and spurred to do some quick online searches about this.

Here is the local article--

http://www.news-press.com/story/news/local/2016/12/16/specialists-in-urology-practice-closing-southwest-florida/95536280/


Apparently, the Specialists in Urology group was bought by 21st Century Oncology, and this company was over extended debt-wise and rapidly going broke, failing to make a scheduled loan payment last month. The electronic health records were hacked, and there was a whistleblower act that resulted in heavy fines to Medicare. Bottom line, I smell bad management and bad planning resulting from greed. I think perhaps they were all too quick to jump into things they didn't fully understand, nor fully implement. I'm shocked and saddened to see so much effort and investment go to waste, but most importantly these abandoned patients are left without continuing urologic care. These are mostly prostate cancer and bladder cancer patients, not easy for another doctor to enter the picture without serious hiccups. I'm very disappointed in the government push for EHR and consolidation to help populations and make disease management more efficient--blah blah blah. The reality is that these government led mandates don't thrive well in the deep trench of medicine, much less in a subspecialty like urologic cancers. When the infrastructure and government mandates strangulate innovation and growth and encourage willy-nilly consolidation, it will inevitably end in divorces and unhappy doctors and patients. I don't know what will become of either but I hope they all find a way out of the mess. Like my patient said, "all my doctors left town". He has found a urologist in a town 50 miles with whom he will continue his care.

Upon leaving, he told me he was grateful that after 15 years of being his dermatologist, I'm still here. I told him, so am I.

Doctors under Attack

We're attacking everybody, lets also attack the doctor!

I've been accepting Medicare assignment for 17 years. Many patients in my practice have Medicare far longer than they have ever had any other third party payor. These are advanced octogenarians and folks into their 90’s. The biggest cause for attrition? They simply pass away from old age. 

Retirement plans (from their workplace) have been shifting retirement benefits from providing supplemental policies to Medicare to now they transfer all health insurance to a private payor which requires new contracts and affiliation and rate schedules to be signed. 

These are not bad companies, but they do have bad practices, with mergers and unclear guidelines for claim filing; call centers in India and Philippines;  I cannot speak to a rational human to get answers. 

I have no choice but to stop accepting assignment altogether on those plans. 

This leads to unpleasantness. Patients angry and bullying, dictating to staff what they will and won’t do. Telling my office “you don’t know what you’re doing”. They do not want to hear the bad news, and I'm not the only one. My local hospital has big signs allover waiting areas "WE NO LONGER ACCEPT XYZ PLAN", etc.

Patients feel entitled and invested in the third party payor process, yet they do realize they do not control the relationship with their doctor any longer. The third party payor dictates who the patient will see, and these requirements have exploded over the past 5 years. The infamous "if you like your doctor you can keep your doctor" a shameless political slogan has now turned into ugly reality--if you like your doctor, you cannot keep her. In fact, it's a guarantee that you'll be switching doctors. The industry, from my micro vantage point, is in constant churn. 

These private plans demand claim filing electronically thru their proxy website, signing of contracts and accepting treatment and payment protocols, thus stripping the doctor of the right to be a doctor. Stripping the patient of choice. 

Why don’t you just go to Aetna then when you have a bleeding tumor, let them attend to it.

This is the broken system with the only accessible professional, the doctor, left holding the bag to deliver the bad news. 

We are all human beings and deserve dignity in this mess that was thrown into our laps. As I read a quote by Boy George, "we're all just clinging onto a rock, some have a better grip than others". I am not offended nor upset if patients need to change doctors. Just as I am a doctor and may need to switch patients! It's a two way street of consternation.