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	<title>Comments on: Medicaid enrollees to sign a &quot;personal resonsibility contract&quot;</title>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63632</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Tue, 30 May 2006 10:41:00 +0000</pubDate>
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		<description>Sorry, wrong time. That was directed to the post before you, 9:41.</description>
		<content:encoded><![CDATA[<p>Sorry, wrong time. That was directed to the post before you, 9:41.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63624</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Tue, 30 May 2006 03:32:00 +0000</pubDate>
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		<description>I think he just got the anon&#039;s mixed up. I was typing as the other anon and I&#039;m sure his commment was for me.</description>
		<content:encoded><![CDATA[<p>I think he just got the anon&#8217;s mixed up. I was typing as the other anon and I&#8217;m sure his commment was for me.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63623</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Tue, 30 May 2006 03:26:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63623</guid>
		<description>Anon. 8:05:&lt;br/&gt;&lt;br/&gt;Did you get the posting time wrong or did you just not read my post? I believe I explained exactly what you have said.  Believe me, I understand the issues relevant to accepting Medicaid in a private practice as well as anyone who does that can. I also know that accepting any more than a small minority of a practice census from Medicaid can wreak havoc with a practice&#039;s finances and put that practice financially under water. Read my post again.</description>
		<content:encoded><![CDATA[<p>Anon. 8:05:</p>
<p>Did you get the posting time wrong or did you just not read my post? I believe I explained exactly what you have said.  Believe me, I understand the issues relevant to accepting Medicaid in a private practice as well as anyone who does that can. I also know that accepting any more than a small minority of a practice census from Medicaid can wreak havoc with a practice&#8217;s finances and put that practice financially under water. Read my post again.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63604</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Tue, 30 May 2006 00:05:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63604</guid>
		<description>Anon 10:40, your major error is in assuming that $34.00 per visit represents the doctor&#039;s net income, not a payment to the practice. As has already been explained, a majority of the income for the whole practice goes to overhead (lease for the office space, salaries for office staff, liability insurance, utilities, the cost of claim submission, etc)with whatever is left over going to the doctor as &quot;profit&quot;. These costs are pretty much fixed regardless of how much the doctor brings in through billing. So assuming that per patient the office needs $40.00 to cover daily overhead, and with the average private insurance/cash paying patient yielding more like $60.00- $100.00 per visit, the physician has a handsome amount left over from which to garner income. When Medicaid pays $34.00 per visit, yes, the office loses money on that patient.</description>
		<content:encoded><![CDATA[<p>Anon 10:40, your major error is in assuming that $34.00 per visit represents the doctor&#8217;s net income, not a payment to the practice. As has already been explained, a majority of the income for the whole practice goes to overhead (lease for the office space, salaries for office staff, liability insurance, utilities, the cost of claim submission, etc)with whatever is left over going to the doctor as &#8220;profit&#8221;. These costs are pretty much fixed regardless of how much the doctor brings in through billing. So assuming that per patient the office needs $40.00 to cover daily overhead, and with the average private insurance/cash paying patient yielding more like $60.00- $100.00 per visit, the physician has a handsome amount left over from which to garner income. When Medicaid pays $34.00 per visit, yes, the office loses money on that patient.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63589</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Mon, 29 May 2006 04:58:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63589</guid>
		<description>bush hater,&lt;br/&gt;&lt;br/&gt;You are the ostrich.  It is a global economy.  You are in competition with 6 billion on the globe so sorting widgets won&#039;t pay 30$/hr anymore.  Learn some new skills, get a degree, adapt.  Even with all his flaws, Bush has nothing to do with it.  I am adapting by not taking medicaid enrollees anymore.  I will still so charity work which I enjoy but I won&#039;t play the joke of a medicaid game.</description>
		<content:encoded><![CDATA[<p>bush hater,</p>
<p>You are the ostrich.  It is a global economy.  You are in competition with 6 billion on the globe so sorting widgets won&#8217;t pay 30$/hr anymore.  Learn some new skills, get a degree, adapt.  Even with all his flaws, Bush has nothing to do with it.  I am adapting by not taking medicaid enrollees anymore.  I will still so charity work which I enjoy but I won&#8217;t play the joke of a medicaid game.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63588</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Mon, 29 May 2006 04:50:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63588</guid>
		<description>It is not a matter of getting paid &quot;less than we want to&quot;.  It is usually a case of NEGETIVE numbers in many situations.  If medicaid pays 30$ for an office visit and it costs 10$ per patient for malpractice, 5$ cost to submit the bill, and 25$ per patient for staff/office overhead cost then I lost 10$ to see that patient.  This is not a case of &quot;living beyond my means&quot;.  A neurosurgeon friend of mine tells me about a case where he put in a 300$ shunt during 2 hour surgery and saw the child in the office for follow up appointments and got a payment of 50$ from the medicaid HMO for the entire length of care.</description>
		<content:encoded><![CDATA[<p>It is not a matter of getting paid &#8220;less than we want to&#8221;.  It is usually a case of NEGETIVE numbers in many situations.  If medicaid pays 30$ for an office visit and it costs 10$ per patient for malpractice, 5$ cost to submit the bill, and 25$ per patient for staff/office overhead cost then I lost 10$ to see that patient.  This is not a case of &#8220;living beyond my means&#8221;.  A neurosurgeon friend of mine tells me about a case where he put in a 300$ shunt during 2 hour surgery and saw the child in the office for follow up appointments and got a payment of 50$ from the medicaid HMO for the entire length of care.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63586</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Mon, 29 May 2006 04:26:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63586</guid>
		<description>Well, I&#039;m no mooch..I&#039;ve worked for over 35 years and have paid my way. that doesn&#039;t mean I&#039;m blind to what goes on around me.&lt;br/&gt;&lt;br/&gt;I don&#039;t hate Drs. at all. But, when you say that taking care of medicaid pts. is all without pay, that isn&#039;t the truth. It may not be the pay you want or what you get from other forms of ins. but it is not without pay.&lt;br/&gt;&lt;br/&gt;I quoted figures exactly as they were written in the report that I gave you the address for. If that report is wrong then lead me to a better one that is more updated.&lt;br/&gt;&lt;br/&gt;As for the 6 minute office visit, I got it right here on this BLOG. Not long ago Kevin had posted something where some of the Drs. were talking about their visit times with patients  being reduced from 15 minutes to 6-8 minute visits.&lt;br/&gt;&lt;br/&gt;But, ironically, I think Drs. are about the best profession there is. We &quot;need&quot; Drs..BTW...I have good ins..But, I know people who struggle everyday because they can&#039;t get dr. appts. or because they can&#039;t buy their medications. I&#039;am not of the attitude to think &quot;well sorry about you, but as for me, I have really good ins.&quot;  I&#039;am not that uncaring about other people.&lt;br/&gt;&lt;br/&gt;When someone says &quot;I worked really hard all day and made nothing doing it&quot; most of us assume you mean that literally. We don&#039;t understand that what you meant is &quot;I didn&#039;t get paid what I would have liked to get paid.&quot; We can relate to that. We live that everyday. &lt;br/&gt;&lt;br/&gt;Maybe you&#039;re just trying to live a lifestyle that is beyond your means?&lt;br/&gt;Like all those people who use to have really good jobs, and then they didn&#039;t. They had to make adjustments in the lifestyle they live.</description>
		<content:encoded><![CDATA[<p>Well, I&#8217;m no mooch..I&#8217;ve worked for over 35 years and have paid my way. that doesn&#8217;t mean I&#8217;m blind to what goes on around me.</p>
<p>I don&#8217;t hate Drs. at all. But, when you say that taking care of medicaid pts. is all without pay, that isn&#8217;t the truth. It may not be the pay you want or what you get from other forms of ins. but it is not without pay.</p>
<p>I quoted figures exactly as they were written in the report that I gave you the address for. If that report is wrong then lead me to a better one that is more updated.</p>
<p>As for the 6 minute office visit, I got it right here on this BLOG. Not long ago Kevin had posted something where some of the Drs. were talking about their visit times with patients  being reduced from 15 minutes to 6-8 minute visits.</p>
<p>But, ironically, I think Drs. are about the best profession there is. We &#8220;need&#8221; Drs..BTW&#8230;I have good ins..But, I know people who struggle everyday because they can&#8217;t get dr. appts. or because they can&#8217;t buy their medications. I&#8217;am not of the attitude to think &#8220;well sorry about you, but as for me, I have really good ins.&#8221;  I&#8217;am not that uncaring about other people.</p>
<p>When someone says &#8220;I worked really hard all day and made nothing doing it&#8221; most of us assume you mean that literally. We don&#8217;t understand that what you meant is &#8220;I didn&#8217;t get paid what I would have liked to get paid.&#8221; We can relate to that. We live that everyday. </p>
<p>Maybe you&#8217;re just trying to live a lifestyle that is beyond your means?<br />Like all those people who use to have really good jobs, and then they didn&#8217;t. They had to make adjustments in the lifestyle they live.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63584</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Mon, 29 May 2006 02:40:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63584</guid>
		<description>Anon. 7:55 wrote:&lt;br/&gt;&lt;br/&gt;&quot;By refusing to accept what they are entitled to you only make it worse.&lt;br/&gt;&lt;br/&gt;Your the one who has taken their right to receive medical care away.&quot;&lt;br/&gt;&lt;br/&gt;&lt;br/&gt;&lt;br/&gt;What a perfect example of lazy, self-righteous liberal deflection.  Medicaid may be the entitlement of the people you speak of, but having someone work for that kind of payment, when it doesn&#039;t represent fair or reasonable compensation, is not.&lt;br/&gt;&lt;br/&gt;Average of $34 per visit at 6 minutes per visit, you say? Maybe your doctor&#039;s practice, but not mine.  Even if it were true, that is not an especially high figure for gross collections. That&#039;s right, gross collections (you seem to be clueless that we&#039;re talking about receipts for a whole business, not just a doctor&#039;s pay). Now deduct 80% for practice overhead--a higher percentage than average since while Medicaid schedules are discounted, practice costs are not-- then you are looking at a more realistic estimate of the doctor&#039;s share. And remember, that is for seeing ten patients an hour, a practice sweatshop.  The doctor only gets paid after the eighth patient is discharged.&lt;br/&gt;&lt;br/&gt;Your figures are as fake as your argument and your ridiculous effort to place the blame for lack of access on those who refuse is to be sweatshopped by the government. You write as if you hate and resent doctors. You obviously resent the fact that they earn good incomes (and you completely fail to appreciate the time and cost that qualifying to practice as a physician requires). Yours is the ethic of the mooch, the taker who wants the fruits of the labor but not the labor. Tell me, would you be as indignant if I were a nurse, or a factory worker being underpaid by the government? I doubt it.</description>
		<content:encoded><![CDATA[<p>Anon. 7:55 wrote:</p>
<p>&#8220;By refusing to accept what they are entitled to you only make it worse.</p>
<p>Your the one who has taken their right to receive medical care away.&#8221;</p>
<p>What a perfect example of lazy, self-righteous liberal deflection.  Medicaid may be the entitlement of the people you speak of, but having someone work for that kind of payment, when it doesn&#8217;t represent fair or reasonable compensation, is not.</p>
<p>Average of $34 per visit at 6 minutes per visit, you say? Maybe your doctor&#8217;s practice, but not mine.  Even if it were true, that is not an especially high figure for gross collections. That&#8217;s right, gross collections (you seem to be clueless that we&#8217;re talking about receipts for a whole business, not just a doctor&#8217;s pay). Now deduct 80% for practice overhead&#8211;a higher percentage than average since while Medicaid schedules are discounted, practice costs are not&#8211; then you are looking at a more realistic estimate of the doctor&#8217;s share. And remember, that is for seeing ten patients an hour, a practice sweatshop.  The doctor only gets paid after the eighth patient is discharged.</p>
<p>Your figures are as fake as your argument and your ridiculous effort to place the blame for lack of access on those who refuse is to be sweatshopped by the government. You write as if you hate and resent doctors. You obviously resent the fact that they earn good incomes (and you completely fail to appreciate the time and cost that qualifying to practice as a physician requires). Yours is the ethic of the mooch, the taker who wants the fruits of the labor but not the labor. Tell me, would you be as indignant if I were a nurse, or a factory worker being underpaid by the government? I doubt it.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63582</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Mon, 29 May 2006 01:41:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63582</guid>
		<description>According to this report:&lt;br/&gt;&lt;br/&gt;http://www.hschange.com/CONTENT/505/#tr2&lt;br/&gt;Tracking Report No. 6&lt;br/&gt;&lt;br/&gt;Granted it is a few years old but I couldn&#039;t find a more updated one. It states that more than 70% of physicians spend less than 5% of their practice time on charity cases. &lt;br/&gt;&lt;br/&gt;You always talk about how much time you give away and how you work for free. Where are the facts to support it? I think it sounds like a good thing for you to say but most likely not true. Also that report doesn&#039;t say that those 70% of physicians spend 5% of their time on charity cases, it states they spend &quot;less&quot; than 5% of their time on charity cases.&lt;br/&gt;&lt;br/&gt;As for medicaid, again you want everyone to believe that it is charity and that you really get no reimbursments for those patients. In this same report it tells us that physicians in Ohio were reimbursed 34.00 for each office visit by each medicaid pat. and that ARK. physicians were reimbursed 66.00. Then it talks about NY with a reimbursement rate at 11.00 per patient, but the average was the 34.00.&lt;br/&gt;That is for one pt. during one visit at apprx a 6 minute time frame with the doctor. That is not providing charity. Most people can&#039;t even imagine making 34.00 for 6 minutes of time.&lt;br/&gt;&lt;br/&gt;Physicians (some, certainly not all)are so out of touch with reality that it would be funny if it wern&#039;t for people dying.</description>
		<content:encoded><![CDATA[<p>According to this report:</p>
<p><a href="http://www.hschange.com/CONTENT/505/#tr2" rel="nofollow">http://www.hschange.com/CONTENT/505/#tr2</a><br />Tracking Report No. 6</p>
<p>Granted it is a few years old but I couldn&#8217;t find a more updated one. It states that more than 70% of physicians spend less than 5% of their practice time on charity cases. </p>
<p>You always talk about how much time you give away and how you work for free. Where are the facts to support it? I think it sounds like a good thing for you to say but most likely not true. Also that report doesn&#8217;t say that those 70% of physicians spend 5% of their time on charity cases, it states they spend &#8220;less&#8221; than 5% of their time on charity cases.</p>
<p>As for medicaid, again you want everyone to believe that it is charity and that you really get no reimbursments for those patients. In this same report it tells us that physicians in Ohio were reimbursed 34.00 for each office visit by each medicaid pat. and that ARK. physicians were reimbursed 66.00. Then it talks about NY with a reimbursement rate at 11.00 per patient, but the average was the 34.00.<br />That is for one pt. during one visit at apprx a 6 minute time frame with the doctor. That is not providing charity. Most people can&#8217;t even imagine making 34.00 for 6 minutes of time.</p>
<p>Physicians (some, certainly not all)are so out of touch with reality that it would be funny if it wern&#8217;t for people dying.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/medicaid-enrollees-to-sign-personal.html/comment-page-1#comment-63579</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Sun, 28 May 2006 23:55:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/medicaid-enrollees-to-sign-a-personal-resonsibility-contract.html#comment-63579</guid>
		<description>&quot;who decided it was a right?&quot; &lt;br/&gt;&lt;br/&gt;I guess the govt. did when it approved those people who receive medicaid. They evaluated them and found that they met all qualifications and said &quot;we are going to give you health coverage through medicaid&quot; Lucky them huh! That means they had to lose their homes, bank accounts, cars and anything else of any value whatsoever to be eligible for medicaid. It is not a situation where people go and apply and they say, &quot;Oh well yes, lets give you health coverage today.&quot;  It only happens when people are at the lowest point in their lives. &lt;br/&gt;&lt;br/&gt;By refusing to accept what they are entitled to you only make it worse.&lt;br/&gt;&lt;br/&gt;Your the one who has taken their right to receive medical care away.</description>
		<content:encoded><![CDATA[<p>&#8220;who decided it was a right?&#8221; </p>
<p>I guess the govt. did when it approved those people who receive medicaid. They evaluated them and found that they met all qualifications and said &#8220;we are going to give you health coverage through medicaid&#8221; Lucky them huh! That means they had to lose their homes, bank accounts, cars and anything else of any value whatsoever to be eligible for medicaid. It is not a situation where people go and apply and they say, &#8220;Oh well yes, lets give you health coverage today.&#8221;  It only happens when people are at the lowest point in their lives. </p>
<p>By refusing to accept what they are entitled to you only make it worse.</p>
<p>Your the one who has taken their right to receive medical care away.</p>
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