Why I decided to opt out of Medicare as a provider

Why I decided to opt out of Medicare as a provider

There’s a lake in Northern Arizona where I jog. I call it “my” lake. It used to be filled to the brim, a playground for ducks, geese, Monarch butterflies, rabbits and squirrels. Over the years when I’d jog in the cold mornings, my lake dried away from drought, measured by bathtub rings on the boulders which surrounded it. Today, rust-colored grass fills the space where clear water once lay. The rings on the boulders are un-countable. Soon, my lake will be gone.

When I drove home last night from the clinic, I decided to set ourselves free from the drought which is drying us. I decided to opt out of Medicare as a provider.

Here’s a brief account of what’s been happening.

Medicare patients come in to our little urgent care clinic in Northern Arizona, sick with multi-system disease. They hobble in from their cars or taxis, clinging to the arms of their loved ones (if they’re lucky) or all alone if they’re not, a plastic bag full of medication in their knobby hands. They’re told at the front desk to choose Option 1, 2 or 3. If they choose Option 1, they will have to pay for any additional services provided in our clinic before they leave.

People used to complain about our new policy. But when all the other primary care physicians in this rural area stopped taking any new Medicare beneficiaries, their offices filled to the brim like that lake used to be, charging their patients 6, 7, or 8 hundred dollars a year before they would see them, our patients stopped complaining. They had nowhere else to go.

The number of Medicare patients we see has increased noticeably. Their primary care doctors, now scarce, can’t see them for weeks. And the only other place left is the over-stuffed emergency room down the road.

So they come to us.

At the end of a billing cycle, our net reimbursement on most Medicare patients is about $130.00 for a new patient, $80.00 or less for an established. That’s not too much to ask, considering the difficulty in making some of those complex decisions on very sick patients who we’ve never seen before, inside the span of a short visit. But it takes 30 – 45 days for us to get that desperately needed money back into the business, after a mound of paperwork, time and cost, a 6% billing fee and the constant fear of Medicare hold-backs. Imbedded inside this is the fear of missing something clinically important in that short visit; an elderly patient whose family has abandoned him and who can’t remember why he came to see us in the first place, let alone the names of his complex list of medications.

Our billing company keeps telling me that Medicare is cutting back, again. They tell me Medicare won’t pay for this, and for that, and for this, or that. It becomes difficult to tell a trembling patient straight to their face that they have a fractured ankle, and then watch them hobble out of the clinic on a broken leg, knowing that we won’t be reimbursed for the cost of giving them an expensive boot and crutches. It becomes difficult watching a chest pain patient make the decision to drive himself to the emergency room against medical advice because he’s afraid of the cost of an ambulance, knowing he could never pay it.

It’s tough, knowing that at the end of a billing cycle of 30- 45 days; we may or may not be paid our $40 or $50 balance, depending on Medicare’s new rules. That $40 or $50 dollars is sorely needed to keep the lights on these days.

It becomes difficult to know that the provision of services by a nurse practitioner or physician assistant will come at 80% of what a physician would bill, and that $40 or $50 dollars gets drained down to $32 – $40 dollars.

We have a great cash pay option for people who don’t have insurance. For $75 dollars, anyone can come to see us anytime if they have a loyalty card, purchased at a nominal fee. They can receive any additional services of their own choice, each charged separately for very reasonable costs. For example, an x-ray of any body part is $50 dollars. An injection of an antibiotic that has the potential to save an extremely expensive visit to the emergency room and possible hospitalization is $40 dollars. Our net, after treatment of those same Medicare beneficiaries, would be around $130, collected immediately at the time of service.

There would be no additional fees to be paid to a billing company so they can play games with our government. There would be no additional fees in bad debt or collection agencies. There would be no worries about committing fraud, incident-to billing, or the miscellany of other punitive rules, policies and regulations which have become exponential as America’s healthcare crisis spins out of control.

There would just be a doctor and her patient, and no one else in between.

Like that lake where I jog in the mornings, I’m watching our Medicare program run dry. Nothing will be left of it soon but a bunch of crusty old bathtub rings, and no one else to care.

It’s the hardest thing as a doctor, a humanitarian, a human being to watch others hobble in for help that you could give, clutching their plastic bags and know that you can’t give them what they need. Providing what they need would lead to your own financial demise, and the lights in the building would go out.

It’s the hardest thing to know that very soon, all that will be left of that beautiful lake, will be a field of rust-colored grass, with no living creature around for miles. The rabbits, butterflies, ducks and squirrels will be gone.

Doctors should be angry. Patients should be angry. You should be angry, too. But, it’s in these small acts, one by one, as hard as they are, that together through our pain, we can change this world.

Natasha Deonarain is the founder of The Health Conscious Movement. She is the author of the upcoming book, The 7 Principles of Health and can be reached on Twitter @HealthMovement.

Image credit: Shutterstock.com

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  • http://twitter.com/seumedico Consultor Médico

    Natasha, Medicare seems to me, an on looker from far away (Sao Paulo), a system designed for the poor, whereas insurance is for those who can afford it. How good (or for the matter, bad) is the private insurers compared to Medicare? Do they give providers the same hard time to receive their billing?

    • http://twitter.com/KathyAMorelli BirthTouch.com

      As a provider, I can tell you private insurers are terrible to us as well. We are being driven out of the insurance panels and I want to be on insurance panels, as a service to the community and my clients,. But is not a living wage, to keep the lights on, to pay a mortgage, to pay a car payment. I drive an old Ford with 92,000 miles on it.

    • http://www.caduceusblog.com/ Deep Ramachandran

      Medicare covers almost every older individual, regardless of financial status. As a physician medicare can be difficult to deal with. The private insurance markets around the country vary greatly, some are more difficult to deal with, some are easier. Where I practice, many of the private insurers are even more difficult to deal with than medicare often requiring reams of paperwork to get anything gone. The increasing concern with medicare is that payments for physicians are going to drop further, coupled with the fact that medicare is getting aggressive at auditing care providers in order to find deficiencies to get money back. This is often referred to by govt officials as cutting out waste, fraud, and abuse.

      • Joan G

        Ah – now we’re in my area of expertise! The easiest defense against a fraud audit is to do the coding/billing right to start out with. Given that this is the area of healthcare I’ve practiced in for the last 13+ years, I can say, unequivocally, that the 95+% of the problems that providers have with the Medicare program is rooted in not understanding some very BASIC principles coding, of insurance coverage and claims processing – things that can be taught in 8 hours or less.

        The other major faux paux is with the quality of the documentation. In the “old days”, it was failure to document pertinent negative findings — and documenting for your OWN recollection, rather than documenting with the assumption that you could be hit by a truck on the way home from work – and that your colleague would have to understand what had been going on with the patient in order to provide seamless continuity of care. Today, it’s those d**n EMRs that encourage the documentation of clinically superfluous information in a misguided attempt to supposedly “audit proof” your E/M services.

        IMHO, it’s like going to a foreign country and being surprised that you walked into the men’s room (instead of the women’s room) when you didn’t bother to learn the language or customs of that country before you went there. Yes, Medicare (and other payers) have a language all it’s own. While they may try to explain things in “plain English”, the reality is that “plain English” isn’t the first (or even second) language of CMS. Just like any visitor in a foreign land, if you want to make sure you don’t inadvertently find yourself facing unexpected problems, you need to learn CMS-ese. Once you do, I think you’ll be pleasantly surprised how consistent Medicare coverage is with the practice of good medicine. (although, frankly, CMS staffers could benefit from having some Six Sigma training…..I don’t think they could figure out an efficient way to implement a program rule if their lives depended on it!)

    • http://warmsocks.wordpress.com/ WarmSocks

      MediCARE is for senior citizens. MediCAID is for the poor.

      • JW

        both programs also cover people who are disabled and thus unable to work (with slightly different rules for how and when each apply)

  • Cass

    Why is this not considered theft in the US?

    Seriously. I’m not allowed to go to Burger King and tell them I will pay them $2.50 for a bacon cheeseburger, have someone pick up the burger, then tell Burger King I didn’t really want that burger, that I will only pay for a hamburger, not a bacon cheeseburger, that they’re going to have to wait until the next billing cycle to get their money (if I don’t forget), and then charge Burger King 6% to give me a receipt. Burger King would wait five minutes, and then call the police. Why is it any difference with American insurance companies?

    • Ro

      The author is referring to Medicare patients whose services are supposed to be reimbursed by the Federal government not American insurance companies. So your last sentence should read, “Why is it any different with the Federal government?”
      And I agree with that 100%

  • southerndoc1

    Could you explain what Options 1, 2, and 3 are? Thanks.

  • http://www.7POH.com/ Natasha Deonarain, MD, MBA

    In summary, Option 1 states to the beneficiary that they agree to be responsible for additional payments at the time of service. Option 2 states that the beneficiary wants the additional services, but they do not want Medicare billed. Option 3 states that the beneficiary does not agree to payment of any additional services performed at the time of service, and the provider has no recourse with Medicare. Medicare has now become a system for the poor and aged. It’s benchmark has pulled private insurance down to the lowest common denominator, where private insurance is acting for providers like Medicare. Here’s my prediction. Medicare WILL collapse by 2014. How do you like them apples?? No one wants to publish my predictions, but save this email and tell me if I’m right or wrong in 2014!! So the question becomes…doctor, what are you going to do? Patient…what are you going to do? I think we’re all going to get a call one day from Medicare saying, “Hey, remember that money we owed you, well…it’s all gone. Too bad, so sad.” And once Medicare falls, so will the entire system…

    • southerndoc1

      What do you mean by “additional services?” Thanks.

  • NormRx

    I’m ready, bring on the death panels. Why any young person would go into medicine is beyond belief. The government took over health care, what is to stop them from requiring doctors to treat Medicare and Medicaid payments, if they don’t they could just pull their license.

  • ZRL PA-C

    Very insightful article. It puts a personal perspective on today’s healthcare crisis using a great metaphor. I can certainly relate as a provider the frustrations with Medicare and feeling like you can’t adequately treat because of costs. Furthermore, it’s a shame patients are having difficulties with primary care because they indeed end up seeking care at Urgent Care…making it difficult for providers who aren’t routinely used to managing chronic conditions in complex patients. Well written.

  • Homeless

    “There would just be a doctor and her patient, and no one else in between.”

    There is money in between your and youre patient and ultimately I can’t trust your judgement because you make a profit off me.

    • rswmd

      You can’t trust anyone you buy something from? Sounds tough.

    • pwsmd

      evil,evil profit. Better for the doc to be in an ACO where you won’t know their profit (“savings”) is based on limitation of your care. People do what they are incentivized to do, doctors and patients,all.

      • Homeless

        It’s clear that you would put profit before my health because of financial incentives…wasn’t that my point.

        • John Henry

          And a misguided point, at that. If I charge you what I think is fair for my services, I don’t do that in a vacuum. You have a figure in mind you are willing to pay, and someone else offering the same services might offer you a better deal than I do and entice you to see him instead. Still someone else might offer you a price and a guarantee your charge would not exceed a certain figure. Almost anything might be possible to get you to take your business to a different doctor.

          I have to charge a figure that covers my costs and a fair return on my efforts. If I can’t charge that, mandating that I provide the service at a loss quickly becomes an unsustainable condition.

          • Homeless

            “I have to charge a figure that covers my costs and a fair return on my efforts”

            Even if that means an unnecessary test?

          • rswmd

            You do know that most docs make no money off of any tests or procedures that they recommend? Ordering tests and reviewing the results and following up on those only increases the amount of unpaid work the doc is doing.

          • John Henry

            Uh, no. It means I have to receive fair compensation for the necessary things I have to do. Or do you have a problem with that?

        • http://warmsocks.wordpress.com/ WarmSocks

          As a patient, not a physician, I don’t understand your philosophy. If you go to the grocery store, they don’t care about your health; they’re looking to make a profit. They’ll sell you twinkies or candy or anything else as long as they make money selling it to you. If you get into legal trouble, would you eschew the services of an attorney? After all, he won’t care about you, either. He would only represent you because it’s his job. He does it for the money. When you need clothes, it’s the same situation. People selling clothes don’t care about your health, either. If you get sick because you’re too cold this winter, it doesn’t affect them one bit. They’re just looking to make a profit off what they sell.

          I’ve found that doctors actually do care – at least more than the average stranger. Either that, or they’re mighty good at pretending. I’m sorry your experience has been different, but that doesn’t automatically mean that all doctors are money-grubbers who put personal profit ahead of the needs of the patient. I’ve found that a frank discussion with my doctor about what I can and can’t afford to be quite helpful.

          Do you go in to your appointments with the attitude that it’s a professional consultation with an expert (“I’m sick. Here are my symptons; here’s what I’ve tried on my own; here’s what’s helped and what’s made things worse. Can you figure out what’s wrong and help me get better?”) or do you approach your doctor as a vending machine, expecting him to spit out whatever prescriptions you order? Your attitude going into it can make a big difference in how you’re perceived and how the doctor responds. I say this only because your attitude in this thread, automatically assuming things about the motives of people you’ve never met, makes me wonder if you also express that attitude to the doctors you see 3D. Most people are more inclined to help those who are nice instead of antagonistic. If you’re respectful of the doctor’s expertise, but are still having trouble, then it’s probably time to find someone you mesh with a bit better. Good luck!

          • buzzkillersmith

            Twinkies!! They will soon be extinct. How did you know that? Are you part of the conspiracy?
            As for me, I’m heading down to Jam’s Minimart and buying their whole stock. Take that!!

          • Homeless

            My attitude towards doctors has been developed over years of being treated like a commodity. I used to feel doctors were on my side but experience has taught me otherwise. If you don’t think that doctors over-test and over-treat, you might want to do some research.

          • http://warmsocks.wordpress.com/ WarmSocks

            There’s plenty written about CYA testing, as well as testing instead of taking the time to get a decent history. Those are generalizations about large populations, but they’re not true everywhere. If you think your doctors are ordering unneeded tests, it’s not that hard to ask the purpose of said test and decline if it isn’t really needed. When patients take some responsibility, the over-testing disappears.

            In any event, this doctor wrote about a problem with her business model, not about your & my experiences with different medical practices. When multiple doctors write about the financial realities of needing to run their medical practice as a business, maybe it’s time to figure out how to fix the problem.

            Imagine that it cost you $5 in gas to get to work and $200 in overhead to keep your doors open, then a client came in and said they had tons of work for you, but would only pay $150 per day. That’s what’s happening, on a much grander scale, to some doctors. Medicare pays my mom’s doctor $42 for a 15-minute office visit. That means he gets $168 per hour for seeing similar patients, but between a nurse and a receptionist and an office manger, plus power, water, heat, office supplies, medical supplies, and malpractice insurance, his overhead is more than he’s bringing in. Where I live, no primary care doctors are accepting new medicare patients. None.

            I talked with an MD not long ago. Great guy. He was fixing my septic tank. Yep. He’s no longer practicing medicine because he can make more money and have a better quality of life as an independent plumber than as a doctor. What does it say when we’re paying plumbers better than physicians?

          • Homeless

            Imagine it costs $20 in transportation fees, and a half of day off work, a $40 copay to get to a doctor who spends 10 minutes recommending unnecessary tests and procedures.

            Of course my comment pointed out the fact just because Medicare is not involved doesn’t mean it’s just the patient and doctor. How do I know this doctor isn’t going to recommend an unnecessary x-ray to pad her bottom line?

          • yukonheart

            Mindless

          • deltalmg

            It doesn’t even have to be for CYA reasons. Medicine is a science there are differing opinions about just about anything. So … should I get that x-ray or not? Well it “might” be a good idea according to that paper I read and it would give me another $50 in my pocket so … It isn’t just CYA money will push the debatable decisions towards whatever pays the most because at the end of the day it is a coin toss where you get to decide which side it flips on.

          • yukonheart

            wow i dont know any family physician that make money off of ordering any test

          • yukonheart

            hmm wonder if being sued for not ordering the test or not ordering the medicine has anything to do with that?

          • davemills555

            What else do you expect when the incentive of fee-for-service medicine is to do more so you get paid more? The incentive to heal is the least of their priorities. A person that is healthy is not sitting in the doctor’s waiting room. An empty waiting room is a very bad thing for doctors. Any questions?

        • Benjamin

          Do you work? Do you expect to be paid for your services? Or are you living in a society where you take everything and not give back. Expecting to be fed, clothe, cared for for free at other people’s expense and time? It seems that you are against any form of compensation for any services. You are obviously a freeloader. Because if you do work and expect to be paid then why shouldn’t physicians who did put in the effort with years of hard work not be paid for taking the time to care for you?

          • Homeless

            I am not implying that doctors should not be paid for their services. I have had many experiences where it was clear that the test or treatment being recommended by a doctor is not in my best interest but for profit for the doctor.

            I am salaried. I do my job to the best of my abilities, even if that means spending more time with someone without further compensation. I don’t recommend things just to line my pocket.

          • yukonheart

            I am not aware of any DOc who does this – they get paid for the office visit whether they order ten test or none matter of fact I would much prefer a situation where I dont have to order any tests – its much easier on staff and actually costs less

    • azmd

      So you would only trust someone who provided you with free services?

    • constitutionalist

      Would you trust your lawyer? Your independent plumber? Your vet?

      A doctor does not make “a profit.” A professional is paid a fee for his or her special skills or knowledge the he/she employees to help his/her client. A true professional has only his/her client’s interest at heart and is never looking over his shoulder at what his employer (Medicare, Blue Cross, United Health) etc. might be thinking. That is why managed care is inherently unethical. It coverts a professional into an employee who then must pretend to serve two masters.

  • John Henry

    Repeal the 1986 ban against balance billing. If medicare wants to lowball, the patient can decide how much more than their pittance they are willing to add to buy the services they want. It is time to make the government give up the lie that it is possible to control prices when costs are at the mercy of the market. The ban against balance billing was done to give politicians the privilege of telling voters they didn’t have to worry about paying anything more than the 20% of the arbitrarily fixed (and now hopelessly inadequate) medicare rate. Keeping this up is the road to ruin and ultimately black markets when patients realize that what is available at Medicare prices (if anything) won’t be anything recognizable as medical care.

    • deltalmg

      The shaman will see you now. I did remember to bring your duck right?

      Things cost money politicians like the illusion that they can promise whatever they want to and either borrow or just refuse to pay what it costs to delivery on the promises.

    • http://journaltowellness.com Kathleen (Kathie) Clohessy

      Balance billing will create an even more inequitable system than already exists. Those on Medicare who have big pensions to help pay the bills will get “elite” services (which they already do to some extent) and those who don’t will get only what they can afford…in other words “Not much.”

      I know this is a blog written by a doctor and that few people commenting really care about the needs of the poor. But this is AMERICA. When are we going to demand a system of health care that doesn’t require one to have a big bank balance to receive top quality care?

  • buzzkillersmith

    Four more years of this president and two more years at least of this congress. No real change in this election, a holding pattern.
    I suspect continued drift for the next couple years, although January 2014 could be quite interesting. As for your (our) Medicare travails, very few with un-gored oxen care. In truth few of us humans care to see beyond our own noses, lofty rhetoric notwithstanding.
    Embrace the despair, let it wash over you, bathe in it for a time, and then move on.

  • khmd

    I’d really just like to be able to bill for my time just like most other professionals. I don’t want more than I deserve, but with more and more of my hard work being expected for free (prior auths anybody? phone calls? disability forms? etc), I have to spend more and more of my efforts trying to make sure I make money elsewhere (procedures) because to be totally honest, I don’t think I make any net income on patients I see in clinic. I’m not even making that up. Anyhow, if you want the system to be less procedure based and more patient based, just let me bill a fair amount for the time I spend on actual patient care. And when you are calculating that fair amount, please consider the $150 per hour I pay in overhead to just run my office.
    I’m not impressed with what the AMA has allowed Medicare to turn into. Too little too late in my opinion.
    I am seriously considering transitioning my practice to a concierge model.

    • southerndoc1

      No reason you can’t charge for completing disability forms under the current system.

      • khmd

        My plumber wouldn’t consider $10-$25 (we sometimes charge $10 for forms) “charging for his service” and I certainly don’t.
        The form charge is just a tool to:
        1. Discourage patients from bringing in forms.
        2. Placate providers into thinking they are getting paid.
        For many reasons, we actually lose money on forms. I can’t see many professionals allowing this type of practice to continue.
        So you caught me on a technicality. They are not free, but I lose money on forms. That and I give myself more legal risk. I don’t like that combination.

    • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

      AMA allowed? they encouraged. let’s not forget that AMA owns the ICD/CPT coding system and they make A LOT of money maintaining this ridiculous billing system. and guess who benefits from the system? it’s not physicians…. it’s Insurance and Medicare.

      they are MORE than happy to prop up the AMA and keep them in their pockets.

      makes me madder than hell to hear a politician tout the “support of doctors” via the AMA. <10% of doctors are a part of the AMA and most despise the AMA.

      Would love to see the AMA just close up shop and us physicians start over with a new organization that will REALLY represent physicians.

  • Joan

    Thank you for sharing. I am a Canadian RN, we too have a health care crisis.
    My heart goes out to you dear compassionate physician. You did not make the system, your survival is so important to the people you serve. Your hands are yours to serve as you see best. You are not alone in your concerns.

  • Will

    You are lucky you can opt out of Medicare. There are some specialties that are not allowed to do so and live under the rules you describe. So much for this being a free country. Medicare is only one of many government programs that demonstrate the fact that there is just too much government in our lives. We’ll discuss this in another 3 years as we brace for another presidential election.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    You may want to chat a bit with your billing company. In Arizona Medicare pays on average in 24 days, not 30 to 45 (unless the claims are paper or error ridden), and their average denial rate is around 4.5% in your area.

    http://www.athenahealth.com/our-services/PayerView/healthcare-reimbursement.php

    I find hard to believe that Medicare doesn’t pay for fixing broken legs, and Medicare pays for ambulance service. There may be lots of things wrong with Medicare, and paying peanuts to primary care is one of them, but they are not the worst payer out there, so why just quit Medicare and not all payers? I don’t even dare ask about Medicaid….

    • http://www.facebook.com/scottstall Scott M Stallings

      I am practicing in Utah and the part about not giving DME such as boots and crutches is true. If the patient leaves with them, they are going to be a gift from us because Medicare does not reimburse for it, it is stupid that the rules pit us in this situation but it is where letting Medicare make all the rules has led us.

      • JannyPi

        Cast boots and crutches are billed the DME/HME side, and have been for 30+ years that I was in the DME business. Lots of patients would come in, directly from their Dr, with a script. In my OPINION, it helps cut down on the appearance of any fraud, or loading a patient with unnecessary items that could occur if the Dr could bill for them. Think blood glucose test strips and imagine what a wreck our country would be in if there were no “controls”. Lymphedema pumps were a huge abuse item, back in the day.

  • http://twitter.com/DonaldStumpp Don Stumpp

    I think you need to consider dropping your Practice Manager and not medicare. Your office policies seem more broken than anything.
    Check out MGMA and your local State association for some help. For example, mid-level payment is 85% not 80%. Medicare pays a lot faster than what you are stating. And I dont see why you wouldnt be paid for simple acute office visits (you stated you are an urgent care center).
    I hear what you are saying Doctor, but there is more to the issue than just Medicare (IMHO without knowing all the facts! )

    • southerndoc1

      There’s a lot in the original post that I find unclear.

      • Here

        Typical whiny nonsense that plagues KevinMD

  • http://www.7POH.com/ Natasha Deonarain, MD, MBA

    For those who suffer from severe myopia, as I do, I recommend “The Leaderless Revolution” by Carne Ross. This articulates the power of what you and ‘we’ can do to change our healthcare system, as taken from a big-picture viewpoint.

    America is sick – - physically and systemically. Both patient and doctor have allowed the deceitful belief systems of external stakeholders to keep us in fear of our bodies, health, minds and will-power to take control. They have convinced us that we cannot be healthy without health insurance, lawyers, government programs, etc. But the joke’s on you. Your health is not a liability. Your health doesn’t need to be insured. We need assurance against the rare instance of disease, not insurance for health.

    Inside this belief system, external stakeholders with aggressive self-interest have turned us into victims of both ourselves and the system, at all levels. Patients feel they must go to a doctor to get healthy. They want the doctor to fix them, and the doctor to blame. Nothing could be more insane.

    Doctors feel they must obey the dictates of a sickened system because it threatens them mercilessly. They feel powerless to stand up against it. They’re afraid of losing licenses, getting blamed for fraud, standing accused and being punished. They don’t want to cause problems. They just want to complain about it, sticking to the tiresome details of billing cycles, bureaucracy, and how unhappy they are in their professions and lives.

    America’s system is based on greed, profit, threat, punishment and disease. This IS the biggest picture possible. How do you expect to get healthy, when you – - doctor and patient – - are surrounded with threat, punishment, anger, blame and accusation?

    But no one really wants an answer, do they? That would require actually doing something about the problem! It would mean you would have to stop arguing about whether I am right or wrong, and whether I’m gouging you for profit as a doctor, and actually change yourself, in alignment with the biggest picture possible.

    It’s much easier to stay right where you are and complain about insane details to distraction, and then act all surprised when we all get exactly what’s coming to us.

    The only way out, is out. Collapse the entire system. It’s sick and it’s keeping you sick. They’re not going to fix it for you. You must do it yourself. Opt out of insurance, Medicare, malpractice – - everything. It’s as simple as that.

    But most of us don’t really want to make a difference, do we? Just like changing ourselves from disease-focus to health – focus, we find it difficult to change our world, because we can’t change ourselves. I often wonder how a tiny little Indian man managed to collapse an entire empire when Americans, the most powerful nation in the world, can’t seem to stand up for each other inside the most basic form of humanity – - our health and healthcare – - obsessively focused on me, me, me instead of us.

    I guess I’m doing what I can. I guess I believe in the power of myself and my ability to change. I guess I still hope. You can join me if you’d like and change the way you see things. Or, you can keep arguing about what they should be doing for you; perpetuating fear, victimization, blame and punishment under a disguise of health-care. I know that each of those stakeholders, who require you to remain afraid, will be eternally grateful.

    • http://twitter.com/PortiaChalifoux portia chalifoux

      Your post and comments touch on many critical points. But one that hasn’t thus far been addressed is that of local/regional collective activism.

      To give an example based on your post’s description, how about encouraging the development of a 501(c)3 group comprised of interested physicians, nurses, other licensed health/helping providers and citizens working with the local and county public health agencies to create a form of ACO which relies on a combination of public health/prevention services (vaccines, screenings, communicable disease prevention, etc), primary care/urgent care clinic and community health/home health services to better manage the at risk population for chronic diseases? Public health funding provides the highest ROI of all direct healthcare expenditures. It is also the first to be cut whenever “austerity” measures and cost cutting rears its Medusa-like head.

      In so doing under a non profit model, community health worker volunteers – heck, volunteers in almost all roles – can be flexibly used to get services to people in an accessible and affordable manner.

      But the other part of the mission would be to advance advocacy for providers to be reimbursed equitably, to be supported instead of harangued by private and governmental 3rd party payers, and to effectively advocate for patients – because this is also being grossly neglected. In the mantra of consumer driven healthcare, we forget that the sick role is one of vulnerability and some degree of dependence. It is markedly different from health promotion and disease prevention, and we neglect it at the cost of preventable and needless suffering and deaths of our fellow Americans.

  • Kevin McD

    Not sure I understand what your solution is here except more fee-for-service type billing. You make it sound like it is the reasonable option, but what if someone comes in who doesn’t have $40 for the antibiotic and another $50 for an X-ray or an additional amount of cash on hand for whatever that X-Ray might find. Do they have to choose which potentially life saving service they can afford that day? This solution only works for customers who have unlimited funds. It works very well for the extremely wealthy.

    The point of insurance, as flawed as it may be, is to be able to cover the cost to take care of a person who is sick. You can’t order your health care a-la-carte. I’m really surprised that you give the example of the senior who drives himself to the emergency room because he can’t afford the ambulance and then present a solution that would force those same people to have to choose the healthcare they can afford on any given day.

    This solution benefits the physician and the physician’s accountant only.

    • dizzydaisy

      You would be surprised what patients can come up with. I think that the biggest factor is that we as a society have become lax in our health among other things. The prices quoted are not that bad at all. The same bill at an er would be several thousand. How does that work? Making hundreds of others pay for what should have been 150.00 or 200.00 for real? I don’t blame this physician at all. Think I will look them up myself. My industry has much the same issue going on. Middle men and bureaucrats fiddling with the numbers, not paying or making us wait for payment, sometimes for as long as 90 days. Insurance was meant to be for catastrophic healthcare, ie, stroke, heart attack, accidents, etc not the flu, common cold etc. This boondoggle has killed the system.

      • Genevieve

        I see your point, dizzydaisy, but neither the author of this essay nor Kevin McD were referring to things like the common cold. Those prices are definitely reasonable, and can probably be an amount that people can come up with, but at what cost to the patient? Having to pay $75 for only one service, or more if they need it, for someone who only has $100 left from their paycheck after paying bills such as rent, gas, electricity, garbage, etc. could mean that they have to take off time from work because they can’t afford to pay for gas, or that they won’t be able to pay for any groceries. Take it from someone who’s been there.

        • dizzydaisy

          I too have been there. Still am. As you know, when something like this happens and you need to get in to see someone, you don’t pay the electric or rent. As a matter of fact, my local electric company doesn’t shut off til after 32 days, and they give you a nifty little note on your door telling you when the shut off will happen, usually 3 to 4 days. The world doesn’t come to an end. We as hard working, bill paying creatures don’t like it is all. I do believe that the 75.00 was for a visit, not a service. The visit might not require any further services, we hope. I for one, still like this model. I’m trying to get catastrophic healthcare for cancer, etc, you know, the big stuff, the way insurance was supposed to be, before the big companies figured out they could make money on basic healthcare! We will see.

    • abrayoungham

      the point of insurance is to con people into believing that other people’s money is better than their own. Any middlemen in any financial transaction are going to pad the margins, in order to have an incentive to act at all as a middleman. Otherwise, what is the point? So the only possible result is an increase in price. From that point onward, it’s an escalating spiral. As people seek to make “the other” guy pay it’s a round robin of increasing costs and bureaucracy, and who profits from that? It’s the tragedy of the commons. It’s the cost of collectivism. It only worsens matter but it has the perennial following as people get seduced by it. It’s the siren song. It’s the God of the Market Place versus the God of the Copybook Headings. Wise men steer clear.

    • http://www.facebook.com/profile.php?id=1820694119 Carol Cowan

      I agree with you, Kevin. The bottom line, to me, is that this is refusing care to people with health problems who have no option that will work for them well. A person must PAY for a “loyalty card”? I doubt if seeing the elderly “hobble in clutching a plastic bag” will be a problem for this clinic any more, they can’t afford to.

  • hadhag

    99.9% of doctors drop Medicare Insurance because it reimburses less than private insurance companies in their geographic area. While the rationalization presented by the above physician is quaint and has been opined numerous times in the press, the question which should be asked is;

    Why do private health insurance companies pay doctors in blue legislature States at higher than Medicare reimbursement rates and in red legislature States lower than Medicare acceptable reimbursement rates for the exact same office visit level or procedure in areas where there is no difference in the numbers of physicians practicing per capita or cost of living? The answer can be found in the anti trust exemption for insurance companies of the McCain Ferguson act and the
    the need for grass roots support of the physicians in that location. Ask a physician in Florida if they’ll ever drop Medicare Insurance which in SE Florida pays higher reimbursment rates than the private insurance companies, you’ll get the same answer with the two industries (gov’t vs. private transposed). Single payer national health insurance would put an end to the fraudulent collusion which exists in the private health insurance industry against doctors and patients.

    • dizzydaisy

      Single payer would also introduce more pencil pushing bureaucrats to the mix. Try lodging a complaint against a government worker some time. They are so protected it’s like bubble wrap. At least a private company can move a lousy employee or fire them.

    • abrayoungham

      Single payer would be the worst possible outcome. It is merely MORE of the SAME failed philosophy that got us into this mess to begin with. Competition drives down prices, monopolies do the opposite.

      • ldsgirl

        I would agree about driving down prices if we were talking about restaurants or toys. But the option to them is to eat at home or at another restaurant or not to buy that toy. The option to expensive health care is not to buy it somewhere else. It may work if you can cover it without the help of employer sponsorship of a plan, or on your own, or if you have no health problems or risky job or hobby or habits to consider, and are fairly young. But add one little thing–a broken arm as a child, slightly high blood pressure, eve–depending on the insurer’s touchiness, you can be up against it. That doesn’t even begin to include family issues. Old age, even middle age, chronic conditions such as epilepsy, diabetes, etc? And if you’re that senior, just wait. People do get forgotten, the poorer they are, the sicker, the older, the more alone, the fewer years they have in one neighborhood, the less likely they are to have any support system, even family, that will be there for them to help or find help for them. Many who have family find that those people have gone off and consider a letter or e-mail as duty done, a phone call as caregiving. How do I know? How would you think? And any medical care gotten to treat the major chronic problems is considered a blessing, however it comes. Medicare is better than Medicaid in many ways, but applying and qualifying for Medicaid is state by state, and some places it is incredibly difficult to qualify. Those who feel nothing for these elderly patients, if you have family in this situation, do your part and see if it changes you. If your heart is in it, both you and they will change.

  • Here

    More doctor bullshit scare tactics

  • Jane Orient

    Good for you. Medicare is the Titanic; you are offering a lifeboat.

  • http://www.7POH.com/ Natasha Deonarain, MD, MBA

    Very interesting discussion. Here’s some more fuel to add to
    the fire. The LAST person (s) we should be asking to reset a medical model is a
    doctor, nurse, health administrator or anyone who is currently obsessed with a
    disease-oriented paradigm and can’t see anything else. For more information,
    please read chapter 1 on my website, in the interest of space which I love to
    use! Studies show it takes a doctor 17-20 years to change practice habits, even
    with evidence-based medicine. Do you think we should be asking myopic,
    fragmented doctors to reset an entirely different medical model that rests on a
    public health perspective, when their thinking is fixated in the minutia and
    detail of a case by case basis?

    THE fundamental problem with America is that it has been
    founded on INDIVIDUAL ideology. We want all this stuff for me, me, me and only
    me. We are not willing to sacrifice for a collective good. This is how the
    entire healthcare system has been erected, and this is exactly the reason why
    it WILL fall.

    When it comes to correcting our system, a COLLECTIVE
    mind-set is needed. All you have to do to see the answer, is drive down the
    freeway and you will understand exactly why America will NEVER get where you
    think it should be in healthcare.

    When we talk about fixing something that REQUIRES a
    collective mind-set, with an INDIVIDUAL ideology at heart, we are talking apples
    and oranges. So, it’s really a waste of time to talk about the details of
    Medicare, billing, administration, malpractice, etc. when the foundation of
    what you want both as doctors and as patients, is flawed.

    The solution – - the only solution I see based on this key
    observation, is complete annihilation of the system at this point. We have run
    out of time and money. Globally, the world is in a recession, and the so-called
    strongest country in it is failing because of this separation of power and wealth
    which it has allowed willingly, steeped in the belief system that I am more
    important than YOU. When the infrastructure of a country of 99% has erected an
    elite minority to serve it…it shouldn’t wonder why there is continued spread of
    wealth and power. The reason lies in defense of individual rights over the collective
    whole.

    So, in answer to your question Portia…pandering to the base
    of current “healthcare providers” is EXACTLY the wrong thing to do, because
    they do not yet see the big picture. I take my inspiration from those who have
    been shut out by medicine – those with terminal cancer who have been told to
    pick out their coffins (seriously) and had the doors of the esteemed
    Institution of Medicine slammed shut because its proponents couldn’t get over their
    own egos and judgments and offer collaboration and optimal health options for
    them to LIVE in the time they had left. I humbly bow down to those who have had
    the unbelievable courage to stand up for their very LIVES against this
    condemnation, and find a better way to heal. And believe me, what they found
    was well outside the confines of a narrow-minded paradigm that begins in
    disease and works backwards from there to proudly declare “Yes, my child, you
    are healthy!”

    No, change will come from the people and it will be for the
    people. There is no leadership in health from a disease-infested institution.
    These are not the leaders we need, and so, as a patient, you are left to forage
    for yourself in the forest of this mess. Patient-centric models are the first
    step. Doctor, you are being booted out of the center of the model. And the next
    step WILL be the paradigm from which you operate. A behavioral coach,
    nutritionist, life-coach, herbalist, acupuncturist WILL be more important that
    you, doctor, because you are the end-stage disease manager of a very sick
    system…and the world is now DEMANDING healthcare. Stop wasting time with the
    distraction that you are going to fix it, embrace the shift in roles and
    collaborate fully amongst those who do know much more about health and enjoy what you are instead of fighting over it and wasting your time!

    Don’t like what I’ve just said? Great…but you and I both
    know its coming. Now, once you accept that, you can sit back and do what you do
    best, and that’s care for disease, not deliver health.

    • rswmd

      “Don’t like what I’ve just said?”

      No, don’t understand what you just said.

      • davemills555

        Went to sleep reading it.

    • Brad Stephan

      The fundamental change needed is a change in the financial incentive – from fee-for-service that rewards illness and injury, toward prospective payment systems that reward wellness and population health management.

      • Courtney84

        I don’t think the problem is greedy doctors who are doing tests for the individual fee, though I do think it would be better for everyone if physicians were paid a salary instead of per-service. I think a major part of the problem is that consumers of health care have no idea what anything costs. I love this doctor’s cash model because when you consent to an x-ray at her facility you know it will cost $50, and like wise for other tests and services!

        I have pretty standard insurance for a married couple. We pay $288 per month in premiums for medical/rx and have a deductible of $2700 for the medical and $300 for rx. Recently I had a test done on a non-emergent basis. I asked what it would cost at the time I scheduled it. They couldn’t tell me, and said ask when you get your pre-registration call. On the pre-registration call the woman used my insurance info and the order from the physician to tell me it would cost $349. I felt I could afford that I went ahead with the test. When the bill came it was for that $349 test plus two additional tests (all three were imagining) that I was unaware that I had had. The imager took it upon theirself to take additional images from additional angles that were not requested by my physician with out consulting me. The bill was $981. How can anyone make decisions when they have no idea what it costs?

        • http://www.facebook.com/scottstall Scott M Stallings

          Is there any incentive for quality and innovation and hard work if your pay is the same no matter how badly you treat people, how many or few hours you work, etc.? I disagree with physician salary proposition. Having spent 15 years in the military I saw plenty of doctors who were downright mean, uncaring and were rewarded equally as their harder-working colleagues, actually probably more because they had better hours and less responsibility because nobody wanted to see them

        • Mary Connick

          You’re right about care being better provided by doctors on a salary, rather than per-service. Kaiser Permanente in Calif provides a stellar model as to how this can be done.

        • JW

          I’ve had pre-authorization people refuse to give me an amount. “It depends not only on the service but also on the diagnosis code used by your doctor”, they tell me. “We cannot quote you any amount.”

          Great. How can I decide whether or not to approve my doctor’s suggestion for this or that test when I have no clue whether or not I can afford it?

          Plus, my disease is not well recognized. If my insurer sees it as less serious than my doctor does and the insurer reimburses by their conception of what’s necessary but my doctor orders tests by their very different (and more realistic) conception of what is necessary, both I as the patient and the test providers are going to pay for that mismatch financially.

    • yukonheart

      Hey makes sense to me – dont ask the people who work on the assembly line why it isnt working

    • Mary Connick

      Excellent analysis of the big picture. When doctors act more like healers, and less like CEOs, healthcare will improve (and we will lose a LOT of bad doctors).

      • http://www.7POH.com/ Natasha Deonarain, MD, MBA

        Thank you Mary! It’s tough living inside my brain sometimes…but maybe you want to hang out on the upcoming website that’s PRO-active, instead of RE-active, as many people seem to be!! http://www.youtube.com/watch?v=6-IOsBOLG0I
        I’ll see you there ;)

    • Jonathan Renkas

      Shame on you! You’re a physician!? You sound like you need a therapist lady! Demonize and generalize all physicians because they are the “bad guys”. Friggin brilliant! Anything of value in your post is obscured by your rightous indignation” Outstanding! Lets marginalize doctors and deny them a table of developing the “new” model of health care! You should be ashamed of yourself!

      • http://www.7POH.com/ Natasha Deonarain, MD, MBA

        Righteous indignation?? Perhaps you’re looking in the mirror? It was Henry Thoreau who said, “There are a thousand hacking at the branches of evil, for one who is striking at the root.” So, do you have a “Friggin’ brilliant” plan, or will you keep misunderstanding the entire point of the essay and speak out so indignantly BEFORE you think? http://www.youtube.com/watch?feature=player_detailpage&v=6-IOsBOLG0I
        When you figure it out, you’re welcome to join! Hope to see you there ;)

  • davemills555

    My opinion, maybe WalMart or Costco could do a better job with less crying and whining, huh?

    • John Henry

      Sure. Service is available during store hours. You get what they stock, not necessarily what you want. And we get to move you around on a pallet forklift.

      • davemills555

        Sounds good to me! Especially the forklift idea! What you describe is at least as good as, if not better than, what most primary doctors offer today. Sign me up!

  • JannyPi

    I’m going to share some patient facts that might add to this conversation. I hope you will keep these in mind when you are treating your Medicare patients. This is what I pay monthly for Medicare. I am disabled and under 65, so rates might be slightly different.
    Medicare Part A is free
    Medicare Part B $99.90/mth
    Medicare Part B Supplemental $160.50/mth
    Medicare Part D $37.40/mth
    In total, I pay almost $300 every month for Medicare coverage. Tack on another $400-$500 monthly for Rx’s (in my case) and there’s not much left from an average SS check.

    • John Henry

      I pay over double that per month. I’m not disabled, so it’s coming out of my earnings. And my individual deductible is $2500/yr. Rx not included.

      • JannyPi

        Like you, I paid more when I was working, and a whole lot more in COBRA.
        My point was to remind readers that Medicare is NOT free to the recipient. There are some that would like to classify Medicare and Social Security as entitlements.

    • http://www.facebook.com/norman.parsons.18 Norman Parsons

      Medicare Part A is ‘”free,” What have you been smoking?

      • JannyPi

        I don’t pay for Medicare part A, do you?

  • http://www.facebook.com/people/Joe-Frost/1135597959 Joe Frost

    This is almost exactly the same as my clinic. My veterinary clinic. The key is good clinicians and payment at the time of service, you’re on the right track here.

    “We have a great cash pay option for people who don’t have insurance. For $75 dollars, anyone can come to see us anytime if they have a loyalty card, purchased at a nominal fee. They can receive any additional services of their own choice, each charged separately for very reasonable costs. For example, an x-ray of any body part is $50 dollars. An injection of an antibiotic that has the potential to save an extremely expensive visit to the emergency room and possible hospitalization is $40 dollars. Our net, after treatment of those same Medicare beneficiaries, would be around $130, collected immediately at the time of service.”

  • Molly_Rn

    Medicare or universal healthcare for all is the answer; let’s join the rest of the industrialized nations in the world. I really don’t care about all of your republican, right wing, freedom from socialism, crazy tea party reasons you think I am going to hell. So you can whine away.

  • SueB

    All I can say is I am glad you are not my physician or the physician for my parents. Your practice management / oversight company may be part of your problem (as mentioned by another commenter). But discarding Medicare is not going to help the system get better. Big ships turn slowly and it will take a large portion of the medical community to help improve the system.

  • bcp

    Doctors are the only professional that cannot charge higher rates for experience and expertise and the only professional that see their reimbursement rates go down every year for the same or increased services.

    • change is needed

      Really? How about teachers and social workers? How much are they paid for their professional services? Are they somehow less important? Access to health care is a human right and a social service and not a business.

      • http://warmsocks.wordpress.com/ WarmSocks

        Although teachers and social workers don’t submit a bill to those they serve, they are not paid a flat fee. Salary scales increase with experience for these professions. Not so with doctors. Seeing identical patients, an MD fresh out of med school gets paid exactly the same as a physician with 30 years experience. Seeing identical classrooms, a teacher fresh out of college gets paid significantly less than a teacher with 30 years of pay raises. A teacher has starting expectations that salary will be $33K and will increase annually, topping out around $68K. That’s significantly less than what doctors make, but nobody starts teaching expecting to make $200K.

        Rights are not things that people are obligated to give you. Rights are things you’re naturally entitled to and people ought not deprive you of: life, liberty, the pursuit of happiness. Rights are not the same as needs. You need food and water, but you have to put forth some effort to obtain them; nobody is obligated to give those to you. You might get sick and need medical assistance to recover, but nobody is obligated to give it to you. The 13th amendment prohibiting involuntary servitude was adopted in 1865.

  • http://www.facebook.com/eliselevine Elise Levine

    As a practice Administrator, I am curious who does your billing? If you are outsourcing, that may be part of your problem. There is RARELY the attention to detail as if in the office. In addition, it takes much longer to correct things (at a higher cost) if your staff is now researching info for the billing service. If it’s in house, do you have professional biller/coder’s doing your work? In California, the Medicare payment floor is 21 days. Most other payers are under 30 days. How on top of things are your billing staff? If your A/R is out of control, it’s the fault of your mgmt, not insurance companies. Unfortunately the practice of medicine is now about diversifying revenue streams. For years everyone counted on Medicare… has your practice manager (or you) looked at how you have contracted in your area? Have you marketed your practice? Do you do speaking engagements at the local hospital? Your first paragraph seems a bit age-ist as well… perhaps you need to close your practice and go work as a concierge doc at a spa handing the young, healthy and pretty – not those with multisystem disease, and knobby hands.

  • Joan G

    Dr DeOnerain – with all due respect, the information provided by your billing department sounds a little funky. Traditional Medicare is required — by statute — to pay within 14 days of receipt of a clean claim that’s submitted electronically and by the 28th day if the claim is submitted on paper (the size of your organization leads me to believe that you’re required to submit electronically, so you SHOULD be getting paid in 14 days). And if they don’t, they’re required to pay a pretty hefty (compared to bank interest rates) interest on the claim. Payment of the interest happens automatically — it’s one of the factors that I look for swhen doing claims audits for providers. The fact that it’s taking 30-45 days to get paid is telling me that your billing company is having problems with submitting a clean claim.

    Additionally, traditional Medicare (not the Medicare Advantage plans, but traditional Medicare) has evolved to be one of the payers, that frankly, I think is one of the easiest to work with if you know your way around the internet for the simple reason that they publish most of their rules! In other words, with private payers, it’s often a guessing game as to how they’re going to be paying a claim this week, but with Medicare, the rules are there in black and white. That’s not to say that they don’t make mistakes — obviously, they do. But the reality is that if you’re dealing with billing professionals (rather than just “billers”), you’re not going to have the kinds of problems you’ve described in the article above.

    Let me just give you one example – the walking boot and crutches for the Medicare patient with a fractured foot. Even though you are a PartB provider, since those are DME items, they have to be billed to the DMAC for your region, not to the Medicare carrier (now called a MAC). Is this a new rule? Ah — no! I don’t remember the exact year it went into place, but it’s been at least since 1999 – and likely before that! So do you see what I mean by many of the problems you being with your billing service?!

    I’m not saying that your practice shouldn’t opt out of Medicare. Yes, Medicare is facing (as they have for each of the past 11 years) a potential drop — and a dramatic one — in reimbursement because Congress has repeatedly kicked the can down the road instead of fixing the flaw in the sustainable growth rate (SGR) formula that was implemented in 1996. Every year we wait with baited breath to see what, if anything, Congress will do to prevent that from happening (in good years, they figure it out just before Christmas. Usually its sometime in the first few weeks of January after Congress returns after their break). The fact that Medicare is on the table for entitlement reform makes it a little more difficult to predict whether (and by how much) Congress will override the pending reduction for CY 2013. But don’t let your billing company fool you into thinking that the 26.5% reduction announced earlier this month is anything but the same old dance we’ve had with Congress for each of the past 11 Decembers.

    Again, opting out of Medicare might be the right decision for your practice. Please just don’t delude yourself into believing it’s for the reasons given by your billing company. The problems they’re having in collecting your money are problems of their own making. A competent billing company wouldn’t be having those problems.

    [PS: In the interest of full disclosure, while I ran a billing service back in the 90's, I have not done so for nearly 15 years - and do not have any ties to any billing service either. The above commentary about the information provided by the billing service is simply some very high level free consulting advice to look into the billing company's performance more closely. If they're having these kinds of problems with Medicare, they're likely having the same (or worse) problems with other insurance payer sources, too.]

  • Michael Angel

    Not to worry … Barack-a-Claus is coming to town! We’ll all be takers and everything will be free in the great America giveaway. Wake up America before all your healthcare and freedoms are gone!

    • LG

      How many years of Medicare, taxes, “the sky is falling” etc., etc., are you fanatics going to blame on this man get over your racism and fanaticism … by the way his name is PRESIDENT Barack Obama! You wake up and keep up with the only thing that is constant is change. Stop digging in your heels and move forward! Come up with positive resolutions instead of fear and hate mongering!!!!

  • Pslice

    The whole system needs to go to single payer and maybe take a hint from Mayo Clinic where Docs,etc are on a salary, not on a fee for service basis. How can any caregiver “just say no”? The congress had the opportunity to create a single payor, but they chickened out. So sad. Healthcare should be an example of people caring about the care of the health of the nation. I realize that people “work the system”….. I work in an ER with no urgent care in town. So we become the urgent care. But people who smoke, drink, and REFUSE to work use the ER as their clinic and the real problems sit in the waiting room for hours. To me this is a unhealthy system dealing with unhealthy people and people who want to get care for free. Single Payor is the only way we can manage the onslaught. I wish organizations such as the AHA and other professional organizations would gather together and put down the commercial insurances, they are the “enemy” in all of this. Single Payor, salaried health care workers, from the doctors on down. This is a sick system we have in the US. It just makes me so sad that you turn away patients because of the almighty buck and that’s really what it is.

  • http://journaltowellness.com Kathleen (Kathie) Clohessy

    This post made me furious…I am angry at the system but I am angrier at this so-called doctor who think that these “hobbling, homeless masses” have $200 to pay her when they get sick!

    I have been disabled and on Medicare and Social Security disability for 15 years..since I was 45 years old. My best wage earning years were stolen from me by illness, and at 60 years old I am barely getting by. I sold my home many years ago and have long since emptied any savings accounts and 401K’s I had. Every penny I receive goes to rent, utilities, food and medication and by the end of the month there is NOTHING left.

    I pay $100 per month for Medicare..not much compared to private insurance, but Medicare is supposed to be cheap to help people like me get care. And that is not my choice. All people on Social Security MUST pay it whether they want it or not. And they must also have a Part “D” option whether they want it or not… But If I showed up in this clinic with a cough and a fever –and a “loyalty card!” –they would ONLY charge me $75, then $50 for a chest X-ray and another $40 for a shot of a long acting antibiotic ..$165…and whatever I need to pay for my prescriptions. And Dr. “poor me I don’t make enough money from Medicare” thinks this is OK?? What should I give up for that month, doctor? My other medications, eating, or a roof over my head?

    Doctors have a lot of power and if they would just use it properly they COULD implement effective change that would help make the system work. It makes me sick and angry that people like this use it against patients instead.

    thank God I don’t live in Arizona.

  • Kolin H Bennett PA

    I agree. We should bill as professionals without fear of waiting 3 months to get paid and then wonder if it goes away in six months b/c of a coding issue. If the men that put the roof on my house were told if they use too many nails I get my money back, Id be the one getting the psych eval.

  • http://www.facebook.com/people/John-Wickenden/729562456 John Wickenden

    When oh when will you drop all this unnecessary mind-clutter and stop. Worrying patients to death, simply copying the best of Europe where everyone is imply gets treated without needing. To be a human calculator and worrying themselves to death.
    Oh! The outcomes are better.

  • http://twitter.com/CrushTheLeft Rules4FreeRadicals

    The only health insurance anyone should want is the five star gold standard: the medical coverage that Congress and the Executive Branch gives themselves and their loved ones.

    You know, the health insurance that covers six months in a luxury unit at the Mayo Clinic for a soon to be indicted Chicago Machine U.S. Representative.

    By the way the Mayo Clinic in Arizona Primary Care physicians dropped Medicare.