The sequester, a last minute harikari device employed a few years by Mr. Obama to get the debt ceiling raised, will drop Medicare payments to physicians for some reason on April 1st. I can't find anything on the CMS website about this, au naturel.
The hilarious thing is the guy says the Repubs invented it. Some of us have excellent memory and refuse the obfuscation now thrown at us.
Govt will kill the goose and then what? It's an Orwellian world, we are in it. It's not coming, it's here.
Clear Stream
Monday, March 4, 2013
Wednesday, December 5, 2012
Jr must be included
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.
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.
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.
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