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AZRogue
03-21-2010, 12:44 AM
I don't feel like starting my own thread because I don't think the blurb of info I'm posting is worth it, so I'm hijacking this perfectly good, and entertaining, Health Care related thread to interject my little bit of non-news.

After a wonderfully tense and brutal partners meeting with the physicians tonight, where I was asked to show my progress in implementing our new EHR system (I'm doing well, and ahead of schedule, but can't make some of the denser docs in the group understand that this is a different program from whatever app they used in the past so, no, it doesn't work exactly the same way, it just accomplishes the same things. If they wanted the app to function exactly the same way as their previous apps, they shouldn't have ran off half-cocked and bought a NEW one), I'm home.

Not exactly my idea of a great Saturday night. Once a month isn't so bad, I suppose.

Still, the big news of the night wasn't my progress on our new EHR. It was the decision by our physicians to drop, as an enterprise, all Medicare patients. Yep, beginning 90 days from now, no more medicare patients at all. Just enough time to send out flyers to give our patients on Medicare time to find a new health care group. Only our Hospice division will continue seeing them, but under some dispensation/agreement with the other partners. The problem is, of course, that we're the only real game in town so I'm not sure if this means people will have to drive much further to get a large pool of docs to choose from, or if this will create a "Medicare" vacuum and docs will move in to fill it. I can't imagine the latter, given the difficulty in finding PCPs nowadays. Not all the partners were there, though, and supposedly one of them is big on Medicare patients (he's out in Washington fighting against the health care bill), so there might be more that decide to exempt themselves from the decision. If the bill passes, there'll probably be less.

On a more positive note, we're going to be gathering data on three of the more intrusive insurance companies we see a lot of and warning them that we're going to refuse to see patients with their insurance if they don't change their policies regarding getting authorization for certain tests. They're pissing the docs off by making them jump through too many hoops to get what they consider to be necessary testing done and it's impacting quality of care. They're also going to contact some of the employers nearby who have that insurance and let them know the situation, so hopefully they pressure the insurance companies from that side, too.

Don't know how it will work but we're big enough, now. It's the reason why the docs started banding together into their super-group they have now: to have enough clout by being the only game in town so that they could use that as leverage against the insurance companies.

Funny thing is, though we have doctors from all sides, different countries (India, China, Mexico, a Russian dude), religions, and so on, out of the over 130 doctors and PAs with the company, not a one of them is for the health care bill.

Bleh, just a semi-crappy night of boringness, but I thought it was a big deal dropping Medicare patients across the board that way. No one else got worked up about it, so maybe it's just me, but it seemed like a milestone to me so thought I'd share. I haven't gone off on the subject that much because I don't know enough, personally, about it all, though I know very well the opinions of the doctors I work with. I talk about it enough already, I suppose you could say.

It was worth a blurb, so I posted it here, in Anc's Palin/Canadian health care thread.

Double-bleh! Looking at how long this is, I suppose I WILL make my own thread. But, for amusement's sake, I'm going to cut 'n paste it as is, no edits. :) Yes, I'm easily amused.

I need beer!

Varaj
03-21-2010, 08:55 AM
I wonder how many of those tests they want to run are backed by evidence based medicine (http://en.wikipedia.org/wiki/Evidence-based_medicine)

My understanding is that if more doctors follewed EBM testing costs and insurance costs would drop radically.

Sadly people only look at one side the equation and don't consider the risk of test when they want/request tests and often tests are expensive and risky and those can out weigh the benefits of test in many situations.

Ancalagon
03-21-2010, 11:54 AM
Why are they saying no to Medicare patients?

AZRogue
03-21-2010, 05:16 PM
I wonder how many of those tests they want to run are backed by evidence based medicine (http://www.kaytastrophe.com/vb/redirector.php?url=http%3A%2F%2Fen.wikipedia.org%2 Fwiki%2FEvidence-based_medicine)

My understanding is that if more doctors follewed EBM testing costs and insurance costs would drop radically.

Sadly people only look at one side the equation and don't consider the risk of test when they want/request tests and often tests are expensive and risky and those can out weigh the benefits of test in many situations.

I have no idea. I know that there are some EBM guides in the app we're putting together, along with Drug Utilization Review guides, that will prompt physicians, but at the same time there are docs who don't like a third party getting between them and their patient. How many actually follow such things, I just don't know. When we are all up and using the new application, we can more easily tell. That might be one reason the partners are eager to implement it; greater insight into quality of care at some of the satellite practices that currently are little islands unto themselves though the enterprise shares liability. The Champion physicians will be able to more easily run audits when it comes to best practices.

Why are they saying no to Medicare patients?

Medicare reimbursement are based off a formula (I'm not in billing so don't know the details) that is set by Congress while reimbursement from private insurance is negotiated. That's why the different doctors in the area banded together to form the enterprise they have, to give them greater negotiating power when it comes to reimbursement rates. Also, Medicare has greater restrictions and is less forgiving when it comes to reimbursement than private insurance. Medicare, it's like filling out your tax forms, if you screw up or make a mistake or don't include the proper page of the exam because you copied the page right after when you sent it in, you don't get paid. Private insurance companies send out people to make sure we're filling out their forms correctly and have process in place to let us know when a form is missing information and allow for it to be quickly fixed so that payment can still be gathered. With Medicare, by the time they realize there's been a problem it's already too late to get paid.

And that's besides the fact that Medicare is reimbursing nearly half the rate of private insurance right now. If you throw in the fact that we can negotiate better rates with private, the difference gets even larger. Since most of our family doctors are in rural Arizona, they have more clout as rural AZ has much less doctor-to-population ratio than the national average.

They can afford to be choosy as they already can't see all the patients that want to be seen. Many of them are already not accepting new patients due to size and non-emergent visits are booking out a month, or up to three months for some of the popular doctors. They feel they can be picky and, right now, with the doctors all being forced to buy computers (most only had a few, and not for a EHR since they are paper chart offices) and new electronics, they are feeling the bite in their budgets. The billing office says we write off millions of dollars a month, for various reasons, and they're looking to cut that amount to cover new costs.

The Winslow
03-22-2010, 04:52 AM
I don't feel like starting my own thread because I don't think the blurb of info I'm posting is worth it, so I'm hijacking this perfectly good, and entertaining, Health Care related thread to interject my little bit of non-news.
<snip>
Double-bleh! Looking at how long this is, I suppose I WILL make my own thread. But, for amusement's sake, I'm going to cut 'n paste it as is, no edits. :) Yes, I'm easily amused.
So are we all.

Funny thing is, though we have doctors from all sides, different countries (India, China, Mexico, a Russian dude), religions, and so on, out of the over 130 doctors and PAs with the company, not a one of them is for the health care bill.
If you don't mind asking some of them on my behalf, what are their reasons? I'd be interested in hearing them, if (hopefully) it's more educated reasons than "Obama is a nazi socialist who's going to murder 95% of the world's population in death panels". :)

AZRogue
03-22-2010, 07:19 AM
I will. It's funny, though I work with doctors, it's not something I've gone into great detail with them on. I hear them talking, and have had passing exchanges, but it's still difficult for me to breach the formality knowing that I work for them. I'll try to bring it up, though, for more detailed responses. I know it's not over death panels or other such silliness.