Medicare reimbursement in Alaska

Patients are losing out:

“One doctor in our office, he’s 75, he’s retiring. His patients are coming to the front desk, crying, because they can’t find another doctor. … He had 90 percent Medicare patients. We’re taking some, but I can’t possibly take them all.”

Comments

Anonymous
Perhaps one day the plebeian population will realize that they do not have to tolerate a healthcare system that is set up for the benefite of the providers. This however, would require an overcomnig of the physician idolatry that is so pervastive in our culture.
Anonymous
Nationalize healthcare. I’m all for it and so are the rest of my medical colleagues.
Anonymous
Anonymous 1:03, where do you get any of the notions you posted about. The story is about a retiring doctor. Your seething ruminations about “idolatry” and other impertinent nonsense you write here and elsewhere betrays a not-so-stable psychological state. Are doctors your only peeve, or are dentists and podiatrists included too? Is some sad trauma in your life feeding your boiling resentments, or are you generally resenting all things that seem authoritative. I would say the one with the problem is you.
You do not seem to be someone worth listening to, the way you behave. Sad, really.
Anonymous
Anon 1:25
It is your choice to engage (or not) me in discussion. As far as physician idolatry goes, need we, yet again, discuss how the desires of The Massachusetts Medical Society, as eloquently stated in 1848, that physicians should be “looked upon by the mass of mankind with a veneration almost superstitious” has come true? It is one thing for the plebeians to believe this. It is entirely another thing for this insipid idolatry to seep into the legal system. Special protections for the allopathic community coupled with the continued ability to predate upon others with the post hoc ergo propter hoc logical nonsense that is “clinical causation.”
As far as “seeming authorative…” Perhaps to those that are engaged in the idolotry does allopathic medicine seem authoratative. The providers will have one believe in the same except when they screw up.
When it comes to nationalizing healthcare, it is a concept that I could support, but not with tax payers footing the existing exorbitant after-expense compensation rates for the providers.
Anonymous
1:03/1:49, you have now convinced me it is you with the problem.
Quoting a historical statement written 150 years ago in Massachusetts has absolutely nothing to do with the story about a doctor leaving practice in Alaska in 2006 and leaving former patients to find other providers willing to accept their insurance plan on the terms of that plan. The story is about business and compensation matters, not about “idolatry” or arrogance or about exclusiveness. (The Alaska primary care market is hardly exclusive to physicians; it is where I first saw nurse practitioners in independent practice.) Your attempt to suggest it does is not merely overwrought it is simply not at all germane. You hate doctors, it seems; you think they have too much authority, you ascribe a status to them that even the most arrogant examples of the profession I have encountered would not appropriate, then you attack the profession on that basis. You have a thinking problem. “Engaging” you in a dispute on the inappropriate and irrelevant issues you have tried to inject here is to pretend they have some shred of relevance. They don’t, except in a delusional framework, which I do not share with you.
Seriously, you should find some more appropriate means of expression.
Anonymous
Anon 1:25/2:05
Your inability to grasp or desire to understand the framework of the modern domestic allopathic market based upon its historical foundation is something that only you can correct. I would suggest, as a primary resource, Paul Starr’s Pulitzer Prize winning text “The Social Transformation of American Medicine.” The underlying paradigm at issue in the subject case is much more ubiquitous than just the Alaskan marketplace. The current healthcare market situation has arisen from the deliberate actions of the providers and their lobbyists from the early to mid 1900s. The monopolization of healthcare services by means of legislative feat coupled with an active restriction on the supply of providers has created the current system in which providers have the ability to cherrypick patients while leaving those on government subsidized care without adequate healthcare coverage.
As an aside, I am still waiting for the anon with the claim of 30 new allopathic/osteopathic schools to provide evidence as well as showing an understanding that the Boston/New York market (regardless of per capita provider ratio) do not have a sufficient number of providers to make the markets competitive.
Now, where the the fruition of the MMS 1848 quote come into play? It comes into play in that the sheeple plebeian population is so enamoured with provider idolatry that they are either unwilling or unable to push for reforms that would be in their best interests (while unfortunately not being in the best interests of the providers). This specific case is yet another example of the underlying problem of the provider first healthcare system in this country.
Anonymous
There is an obvious win-win solution here. Let Anna Pou and her accomplices practice in Alaska. Surely Medicare will pay for the universal cure of morphine and ativan.
Anonymous
Thats the same “anonymous” who had no clue that the USA has a higher doctor patient ratio than every other nation on the earth except 5.
Thats the same “anonymous” who claims the AMA is engaged in a vast widespread conspiracy to create an artificial doctor shortage, when in fact the AMA has ZERO CONTROL OR INFLUENCE over the creation of new medical schools.
Thats the same “anonymous” who didnt know that the USA takes more foreign doctors every year than all other nations COMBINED.
Anonymous
1:03/1:49/2:45
You are`way off-topic. FWIW, I have read Starr’s book. I also earn my daily bread in that “allopathic” market, a market I regularly share with those non-allopathic. You imagine, in your closed and flawed understanding, some hermetically- sealed market where none but those with M.D.degrees are able to work, this being untrue and you also conveniently forgetting that M.D.s compete with one another as well.
I cannot help you if you don’t want to see things as they really are.
As far as this story is concerned, the good people of Alaska are still free to petition their government to pay properly on their behalf to those whose services they want to consume but do not want to pay for in full or directly. As far as I can see, it is still the right of any practitioner to decline to accept more than is reasonable in number patients who do not properly cover the costs of what they consume. In fact, doctors are free to not see any Medicare patients at all, although many do not do so.
Your foggy notion of medical monopoly hardly applies to Alaska, where other providers are and have been free to compete in the market for medical care. I suppose it is possible that those non-physician providers might also find Medicare rates unattractive–the report does not say–but that is beside the point. Just because I might offer a price to pay for services I want does not mean someone else, allopath or other practitioner, has to take my offer. As it is, how would opening the market further, presumably to those with no qualifications presently allowed to provide medical care, serve this market better? What evidence have you that Alaska is under-served: merely the fact that some can’t find care at bottom-of-the barrel payment rates? Anyone who wants who has the qualifications to practice can go there. Perhaps the answer is one that should be obvious: it doesn’t pay.
Anonymous
Oh good! I see that you have come back. The question regarding your outlandish claim of 30 new medical schools and your lack of understanding of threshold supply still remain.
The fifth highest per capita provider number translates in what manner to sufficiency and in what manner to having a sufficient number of providers that are willing to take Medicare patients or else go out of business? When it comes to the AMA and CME, you yet again show your lack of knowledge of American allopathic history and the current system. For-proft medical schools? There are none. Medical schools not associated with large research institutions? There are none. Having a small number of medical schools with at most 100-200 seats for an incoming class? Why is this the case? Restricting supply (perhaps)? Taking foreign trained providers from wonderous research institutions such as Tijuana Tech? Goes to show that we are not training enough domestically and the not-for-profit and resarch institution couplings are extraneous and not needed.
The only thing that will break the hold of the physican terror gang on American healthcare is foreign competition. When the cost of airfare for two, accomodations, surgery at a world class hospital for gall bladder stone removal and rotator cuff repair = 10K savings over having the procedures done domestically… companies providing healthcare options for their workers will catch on. You just better hope that the public service sector doesn’t catch on or non-emergency major surgery as we know it in this country is done. It may be for the better. If local and state government could send these cases overseas, the cost savings could go into hiring more primary care providers.
Anonymous
“The only thing that will break the hold of the physican terror gang on American healthcare is foreign competition. When the cost of airfare for two, accomodations, surgery at a world class hospital for gall bladder stone removal and rotator cuff repair = 10K savings over having the procedures done domestically… companies providing healthcare options for their workers will catch on.”
“Terror gang”? You are delusional and paranoid. Why don’t you book a seat on the next flight to Bangalore and get yourself some psychiatric help. Maybe you and your seatmate can swap stories about your employer’s fabulous savings by going the outsourcing route.
Anonymous
Anon 3:55
The few osteopaths that are present hardly account for sufficient “non-allopathic” competition in the market. The other form(s) of providers such as RNs, NPs, etc. do not have sufficient autonomy from the providers to be considered on equal footing when it comes to competition in the healthcare market.
The people of Alaska could give more of their hard earned tax dollars to the providers or they could take the lead and structurally reform the medical system in the state. Allowing for the creation of for-profit medical schools that are decoupled from the AMA/CME “recommendations” such that newly minted providers can only practice in-state with little to no hope of being allowed to practice in other states would create not only a supply surplus but would also retain providers and mitigate the “give me special privileges or I am going to abandon my patients” cries that have become ever to prevalent. The other option is to treat medical care in the same vein as fire and police protection.
Anonymous
“‘Terror gang’? You are delusional and paranoid. Why don’t you book a seat on the next flight to Bangalore and get yourself some psychiatric help. Maybe you and your seatmate can swap stories about your employer’s fabulous savings by going the outsourcing route.”
Crazy like a fox. Unfortunately, the domestic psychiatrists are too busy whoring themselves out to the criminal defense attorneys to find new ways to excuse the behavior of murders, child molesters and other sex perverts. If the practitioners had any shame they would realize the utter and total level of ill-repute to which they have reduced their profession. Road rage becoming a disorder was the last nail in this putrid coffin.
As far as physician terror gang goes, I am glad that my characterization caught your ire. Need we again repost the internal e-mails of the New Jersey Medical Association? Holding patients hostage in order to ring concessions from the legislature? Hizbullah and Hamas only wish that they could achieve the same results with their terrorism. In regards to offshoaring of major non-emergency surgery, read the LA Times article on it. Three Fortune 500 companies are in the process of initiating this option for their employees. Why bother allowing the foreign trained provider(s) to come here and enjoin in the monopoly when one can send patients there, receive the same treatment(s) and do so at a fraction of the cost? The most comical aspect of all of this is to hear physicians cry about patients not having the ability to sue their foreign competition for malpractice, should such occur.
Anonymous
“Allowing for the creation of for-profit medical schools that are decoupled from the AMA/CME “recommendations” such that newly minted providers can only practice in-state with little to no hope of being allowed to practice in other states would create not only a supply surplus but would also retain providers and mitigate the “give me special privileges or I am going to abandon my patients” cries that have become ever to prevalent. “
Try selling that idea to Alaskans. I could use a laugh.
Anonymous
Inherent in your humor is the tacit acknowledgement that the allopathic idolatry would preclude any passage of such reforms. When it comes to stopping the worship of the miracle workers, it would be far easier to get the general populace to stop believing in their imaginary friends in the sky. The populace that has allowed the current system to be foisted upon them deserves exactly what it gets – no or limited access to care with an entertainment of the whining of providers being “killed” or “forced” to abandon patients for only making 100K in addition to the plague of murderers, child molesters and other sex perverts loosed into the community thanks to “expert” psychiatric testimony. The system will eventually change, but it will be at the hands of the socialists and big business (an odd combination to be sure).
Anonymous
“The populace that has allowed the current system to be foisted upon them deserves exactly what it gets…”
I couldn’t have said it better myself…you litigious American animals are getting your just reward…unnecessary procedures, hospital admissions, treatments…we’ll take our $100k to the bank laughing all the way…
Anonymous
6:12,
You are very amusing. I would be interested in hearing your conspiracy views on 9/11, gas prices, the holocaust, or any other topics you are expert in. C’mon, don’t hold back, lets hear them all.
Anonymous
Anon. 1:03/1:49/2:45/4:07/5:12/5:21/6:12:
If you expect anyone who reads what you write to take you seriously, then you must be a wacko. That last paragraph belongs among the sad and jumbled messages that you see on disorganized homemade sandwich board signs brought out to sidewalks by the sorts of folks who wrap their heads in aluminum foil to block out prying microwaves projected by unnamed spy agencies. Is that you?
I’ll give you the benefit of the doubt and assume you meant it as a joke.
Anonymous
Anon 9:10
“…9/11, gas prices, the holocaust…”
No conspiracy, market forces, Nazi Medical Doctors acting in cahoots with Hitler and his ilk to murder 6 million Jews and hundreds of thousands of others. Any other questions? One only need read the historical record governing allopathic medicine in this country to understand how the current system came about.
Anonymous
Anon 7:16
You have confused at least three or four different anons in your post. Kind of like the MD that was referenced in another post who couldn’t tell the difference between a gallbladder and a kidney. Would you like to try again? Perhaps an improved performance would put things in perspective regarding how much weight one should assign to what you consider to be facetious or to whom you are giving passes to.
Anonymous
Anon. 7:16:
How would you know, unless you are the author of those postings and are now pretending not to be?
Anonymous
Perhaps because I know which posts are my own and which ones aren’t.
Anonymous
Gee Anon 1:13 alias Anon 2:28. Where is the fire? Obviously there is some deep-seated truama here. An analysis would be in order. Unfortunately for the rest of us, we can only ponder what life-event has left thee so scarred. Why don’t you go to medical school, assuming you can get in, and walk the walk so you can talk the talk. Otherwise you are entitled to your opinion, but it will not carry much more than featherweight. The best and brightest are increasingly choosing other professions than medicine. I would not encourage anyone to become a doctor for the money. All those streetwalkers you refer to would gladly take care of patients if it weren’t more lucrative to prostitute. Seems to me the cure is to pay them more to take care of patients and eliminate the fat legal rewards that enable attorneys to hire them.
Anonymous
“Gee Anon 1:13 alias Anon 2:28. Where is the fire? Obviously there is some deep-seated truama here.”
Yeah (LOL). That is what it is. How can someone not be appreciative of sacred cows, idolatry, hypocrisy, junk science and special privileges for the allopathic community?
“An analysis would be in order. Unfortunately for the rest of us, we can only ponder what life-event has left thee so scarred.”
Why not take a cue from your psychiatric bretheren and just make something up? Something on the order of intermittent explosive disorder? Or perhaps your rheumatological bretheren with their litigation based junk diagnosis of “post-traumatic” fibromyalgia might be of some help?
“Why don’t you go to medical school, assuming you can get in, and walk the walk so you can talk the talk.”
Commenting on healthcare policy requires a medical degree? Let us look at the prima facie case here. You are dealing with someone that does not hold the allopathic medical community in very good repute (in the same way as a prosecutor might not hold members of a criminal street gang in high repute). Given this as the starting point (I can include the intervening steps in the logical arguement if you can’t see them)I would want to become a physician because ____?
“Otherwise you are entitled to your opinion, but it will not carry much more than featherweight.”
A comment worthy of a physician as only they could make such an arrogant statement. Don’t worry, I also would not want to discuss the issues if I had to argue for retaining the status quo when it comes to allopathic medicine.
“The best and brightest are increasingly choosing other professions than medicine. I would not encourage anyone to become a doctor for the money.”
And yet, the practice of the art of medicine, on a mean after-expense basis, is still the highest paying profession. Again, when the medical schools are going with an insufficient number of applicants to fill their overtly restricted number of seats, will such an arguement be considered reasonable.
“All those streetwalkers you refer to would gladly take care of patients if it weren’t more lucrative to prostitute. Seems to me the cure is to pay them more to take care of patients and eliminate the fat legal rewards that enable attorneys to hire them.”
Let us get this straight. It is okay to find a “psychiatric disorder” in a child molester/murderer to mitigate fault because the criminal defense attorney pays the psychiatrist more money than can be made in ligitamte practice? I have seen a number of excuses for this rather sick and shady behavior, but yours is the most amazing yet (and perhaps the most accurate). The problem with the legal system is not the level of money that can be obtained by the provider, but is instead the inequitable application of the rules of evidence governing expert testimony. If physicians had to undergo the same level of scrutiny as any other field when it comes to the relatively lax Kelly-Frye standard (not to mention the much more rigorous Federal Rules of Evidence 702/Daubert/Kumho Tire standards) they would fail every time when it came to the issue of specific causation.
ismd
“Need we again repost the internal e-mails of the New Jersey Medical Association? Holding patients hostage in order to ring concessions from the legislature? Hizbullah and Hamas only wish that they could achieve the same results with their terrorism.”
Anon 5:21 PM,
Again you lie about what happened in NJ in 2003 – there were no internal e-mails such as you claim. I’m an active member of MSNJ (again, you misname the state medical society), and there were no such e-mails sent out to members. MSNJ did not organize or sanction the 3 day walkout, which, if truth be told (something you’re obviously unable to do), had less than 1/2 of NJ doctors participating. Stop the lies!
Anonymous
Let me get this straight dude. USA has the 5th largest number of per capita docs in the world and thats NOT ENOUGH to treat patients?
My god, how does t he UK operate, in which they have 20% fewer docs per capita than teh US?
How does Canada operate, which has 10% fewer docs per capita?
You are an absolute fool. When we switch to socialized medicine someday, you will quickly see that many doctors will quit, but we will still have plenty to treat the population.
Anonymous
http://www.consumerwatchdog.org/healthcare/rp/1012.pdf
“Cause confusion and inconvenience [for your patients]. Let them know that this is the healthcare system of the future if it is not fixed now. And get every man, woman and child to fill out a petition… If there are children in my waiting room with their parents, they are signing a petition in crayon and we fax it to the Governor, I kid you not!!!”
“Public opinion must be on our side so we cannot alienate our pts(i would agree that it would it is a bad idea to allow pts to come to the hospital for surgery without WARNING them that they will be cancelled or have significant delays. But in the same light surgeons who have cancelled elective cases for that week SHOULD NOT RESCHEDULE) .We can significantly inconvenience them(which is NOT irresponsible) and direct their anger from this to help our cause. Educate them ,have them write letters, make phone calls , write letters to the editor of your local newspaper etc. MOST IMPORTANTLY, our pts must TRULY EXPERIENCE significant delays, inconvenience and INABILITY TO CHOOSE a physician to UNDERSTAND the full impact of what this crisis is all about, and that down the line, without reform, it will not simply be days or weeks but an an indefinite problem.”
“For many years, we have been tread upon by insurance companies,bureaucrats and trial lawyers.We have accepted outrageous decreases in our fees, ridiculous awards for trial lawyers and some patients who think that physicians are their winning lottery ticket due to a crazy tort system and an absurd overhaul of our profession by the bureaucrats and insurers. We have literally been raped and sodomized as a profession. And we have accepted all of this without a fight. All we have done is ***** about it in the hallways but really have done nothing.”
“Any physician who doesn’t wnat to participate shows just how disrespectful he is of his colleagues and of his profession. He should be ostracized by his colleagues both professionally and economically just as any other”scab”
Raped and sodomized? For hundreds of thousands of dollars per year?
Anonymous
“My god, how does t he UK operate, in which they have 20% fewer docs per capita than teh US?
How does Canada operate, which has 10% fewer docs per capita?”
The distribution of healthcare service is a tad bit different in both of these examples. A uniform distribution system (the service may not be the best) can function with fewer providers. A provider dictated system, such as the one that we have, will require more providers to engender sufficient competition in the most lucrative (not necessarily financial as the sole underlying basis) geographical areas to force providers into the rural and urban areas if they choose to have a sufficiently large patient base to remain in practice. If we should ever be saddled with the botched abortion that is socialized medicine, the providers will have little choice when it comes to their assignment.
Anonymous
“How does Canada operate, which has 10% fewer docs per capita?”
Ever been a sick patient in Canada ? ))
ismd
Anon 11:52,
The e-mail you so generously quote comes from one very angry, very pissed off physician in NJ, NOT the state medical society. His views are not those of MSNJ. Please stop perpetuating lies on this website.
Anonymous
Read the e-mail again. I have given the link for the PDF file at the start of the quotes. There were a number of providers involved in this sick tryst.
BTW, what happened to this group from the insane clown posse?
ismd
Anon 11:52,
It is you who is a member of the insane clown posse. It is you who is misinterpreting the e-mail, or as you fondly put it, the “sick tryst”. I know Dr. Shikiar, and though he may be VP of the Hudson County Med Society, these are his views and, again (for the hundreth time), not the views of MSNJ. The e-mail you point to was part of a chain developed at the time of the 2003 work stoppage. Again, MSNJ had absolutely nothing to do with these e-mails, no matter what you may prefer to believe. I know – I’m a member of MSNJ and a very pissed off Jersey doc who is proudly on Dr. Shikiar’s e-mail list. Again, stop spouting half truths and distortions to make your pathetic points.
Anonymous
A proud member of the ICP who supports blackmailing patients? Why does that not surprise me. Holding children hostage until they sign and fax a petition to grant you special privileges from liability while your ilk continue to “rape and sodomize” third parties with your post hoc ergo propter hoc “clinical causation” and pro-child molester psychiatric secundem res “expert testimony?” This is a perfect reason as to why you people should not be allowed to be responsible for the disciplinary actions regarding your own.
ismd
And you are a proud member of Psychopaths Anonymous. Boy, do you ever have the facts screwed up, distorted and misunderstood. No one – I repeat, no one – during the work stoppage in 2003 ever held “children hostage”. Emergencies were covered, hospital rounds were made, patients in ICU cared for, etc. Yes – patients were inconvenienced to make a point – that this was their future if healthcare problems in Jersey weren’t fixed. You don’t have a freaking clue what any of this is about. Instead, you use big words and incomprehensible phrasing (“your post hoc ergo propter hoc “clinical causation” and pro-child molester psychiatric secundem res “expert testimony?”) to hide your psycopathic hatred of doctors and your inability to hold a rational discussion of the facts. The only doing any raping and pillaging is you with the facts and the truth. At least have the courage to sign your pathetic comments.
Anonymous
And you are a proud member of Psychopaths Anonymous.
Yeah that is what it is. Being utterly disgusted with holding patients hostage by the elite who wish to create special privileges for themsevles is “psychopathic.”
Boy, do you ever have the facts screwed up, distorted and misunderstood. No one – I repeat, no one – during the work stoppage in 2003 ever held “children hostage”.
So you say. The e-mails state otherwise. Even the suggestion of holding patients hostage (esp. children) is utterly despicable. I would love to see your arguement that it is not or that the contentions made in the e-mail regarding the same are justifiable. To defend one that would make such claims is equally despicable.
Emergencies were covered, hospital rounds were made, patients in ICU cared for, etc. Yes – patients were inconvenienced to make a point – that this was their future if healthcare problems in Jersey weren’t fixed.
Problems? You mean the physicians getting a taste of their own medicine? It’s fine and dandy when the physicians can profit from PI cases and criminal defense cases when they can destroy the lives of third parties. God forbid that they actually have to be defendants to the same scumbag plaintiffs’ attorneys on the civil side. If the plebeians of NJ were smart they would not give into such blackmail tactics and instead demand fundamental changes in the structure of the medical system to mirror that of the police and fire system.
You don’t have a freaking clue what any of this is about. Instead, you use big words and incomprehensible phrasing (“your post hoc ergo propter hoc “clinical causation” and pro-child molester psychiatric secundem res “expert testimony?”) to hide your psycopathic hatred of doctors and your inability to hold a rational discussion of the facts.
What aspect of my statements did you not understand? Let me know and I will put it into “simple speak” such that even a supporter of those who would hold children hostage to fax petitions in order to create special privleges for their profession would understand.
Anonymous
The vitriol of that last commenter makes me wonder whether the origins of his feelings are indeed personal. Lose a contest on the strength of testimony somewhere that wasn’t in your favor? Could that have been provided by a physician expert witness?
Anonymous
probably some loser jackass who didn’t win the malpractice powerball so he’s confined to his minimum-wage job…
Anonymous
“The vitriol of that last commenter makes me wonder whether the origins of his feelings are indeed personal. Lose a contest on the strength of testimony somewhere that wasn’t in your favor? Could that have been provided by a physician expert witness?”
No and no again. Interesting choice of terminology – “contest of strength” – Is that what the term is for lawsuits these days that involve streetwalker physicians? Unfortunately, it is society at large that looses when it comes to these streetwalker physicians. One could hazard the conclusion that there are far more junk science PI cases clogging the court system (where the physicians are profiteers) than there are med-mal lawsuits. One could also hazard that there many more innocents that would be alive if not for the snakeoil of the psychiatrists in obviating the responsibility for action of murders, child molesters and sex perverts.
Anonymous
“probably some loser jackass who didn’t win the malpractice powerball so he’s confined to his minimum-wage job…”
Try again jackass. Unlike the hypocrtical physicians crying foul when they are defendants instead of profiteers in the legal lottery system, I have not sued anyone.
Anonymous
Anon 5:43 (or should I address you as flaming asshole),
Like ISMD said, no children were “held hostage”, so please stop repeating your pathetic drivel. You have no idea what happened in NJ back in 2003, nor what’s going on there right now. There isn’t even any type of work stoppages or other actions planned at the present time. I also live and practice medicine in the so-called Garden State, so I know.