The Medical Office Fabric Beginning to Unravel

[jmj11]

This was a story on the news this morning in Seattle. A physician threatening to kill employees of Molina (a private - Medicaid insurer) because of their denials. They are the worst of the worst.  If you read about this physician's history, you will see that he has some personal issues.  Also, his threats are of course out of line. But he does represent the frustration, that is growing, with the way insurance companies are treating, especially small practices. It is far out of control and they have no accountability.

 

We are getting more and more rejections of claims, usually for no sane reason except to save them money.

 

While the threat or act of violence should never be tolerated, there needs to be attention paid to this problem because small practices will have to fold or join mega health care corporations. 

 

 

[rev ronin]

Molina profits by denying care to the poorest of Americans.

[Guest Paula]

Our medical system is a mess.  Insurance companies work hand-in-hand with government to ensure that it stays messy.  How much money will insurance companies get with their deals made via the ACA?  

 

I'm getting sick and tired of my patients not being able to see a specialist because specialists won't take straight medicaid.  There is something wrong with that, too.

 

Maybe our medical system should do away with insurance all-together, cash only, and perhaps prices would drop on all the tests and office visits.

 

I don't know the solution to the problem.  With the law that everyone must have insurance sets us up for failure.  I still see numerous patients who do not have insurance and just did not bother to sign up or don't care or are too poor so probably won't ever pay any fines and taxes on their lack of insurance.  One of our major clinics we refer to just put a new policy in place that they will not see Michigan patients on MI medicaid.  Now we have to jump through hoops to find a MI specialty provider (neurology, rheumatology, endocrinology) and our patients have to travel 2-3 hours or to lower MIchigan (5 hours or more) to be seen.  Most won't go or have no reliable transportation.  Plus, another referral source we had was taken over by Wellpoint and they refuse to see any patients without insurance.

 

Case in point.....my patient who needs endocrinology has to wait 8 months before she can get an appointment with the visiting endocrinologist who comes once or twice monthly and she will have to travel 2 hours to the appointment  and enter into a different time-zone too.  My bet is she won't go and I will be stuck caring for a complicated condition that even my SP declines to really handle.  Sucks big time.  Sorry for the rant!  I feel better.

[LoRezSkyline]

Well, at least Molina's CEO only made $11 million last year - which was only $7 million more than the year before that.  And $19 million less than the guy running Aetna!!!

 

For comparison - the head exec of CMS/Medicare's pay last year was $165,000 - which was less than the year before.  But we all know how wasteful and excessive government spending is, right?!?

 

(cue the sound of my blood boiling...)

 

http://www.healthcare-now.org/health-insurance-ceo-pay-skyrockets-in-2013

[jmj11]

There is a pent-up rage building.  Like all of these legitimate causes in history, it is the nut-jobs (this doctor) who are first to cross the line. But then there will be big and sane I hope, movement of people fed up. We no longer practice medicine. We make suggestions to the insurance companies. They then have their nurses or physicians (usually physicians who are retired, license lost, alcoholics and etc.) make the final decision on the care the patient actually gets.  These medical people are so far removed from both the patient and the current practice of medicine of that specialty, it is like a giant step back into the 1960s "Current Standards of Medical Care."

 

I agree. I'm ready for a single payer system as I don't think Congress, with their hands in the the insurance company pockets, will ever have the nerve to regulate them better. 

[Guest Paula]

^^^ Congress will hire insurance executives to manage the one payer system and spread pods of them throughout the country.  Then give them bonuses and raises for denying care to the most needy or sickest or most expensive treatments.   Waiting lists will be developed too.  

 

Our patients will get the short stick no matter what solution is put forth.  

 

Should we go back to getting paid in chickens and potatoes?

[GetMeOuttaThisMess]

Disregard

[LoRezSkyline]

Speaking of overpaid execs - it's not just limited to the insurance companies.  This one's been getting a ton of play on Twitter...

 

http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?smid=tw-share&_r=0

[CAAdmission]

While the threat or act of violence should never be tolerated, there needs to be attention paid to this problem because small practices will have to fold or join mega health care corporations. 

 

You know, if everyone thought like this, We would be a part of the British Healthcare system now. (Not sure if that is a step up or a step down.)

[andersenpa]

in case anyone hasn't visited their site yet:

 

Physicians for a National Health Program

http://www.pnhp.org/

[JohnnyM2]

Our health care system is a mess because voters continuously vote for legislators and presidents who promise them free or very low cost healthcare (and just about everything else) and then try to raise taxes to pay for it all and, finally, drain money out of the system when that doesn't work. Someone once said, "Government does big things poorly and it also does small things poorly." Whenever huge sums of capital are allocated on a purely political basis instead of being allocated by the market place, in programs that are too big and too complex to manage, and then poorly implemented because there is little accountability when spending tax payer money, there will be permanent dislocations and failures. In a free market system, dislocations and failures also occur but the system resets when failed ideas and companies go out of business. Government keeps promising solutions and then fails because central planning doesn't work well in a huge diverse economy like the US. If you teach this to everyone you meet, votes may

 

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[JohnnyM2]

Opps! Wanted to say: ...voters may eventual catch on and change the way the vote.

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

[andersenpa]

The US doesn't have (or intend to have) a "free" market, especially for health care. 

 

And people vote for the most part on party lines (mostly to vote against the other party) and a slim minority ("undecided") determine swing. Even a prominent issue like health care financing can't push it. And the icing on the cake is that no one was promising free healthcare, they were imposing the need to buy private fee for service insurance.

[hlj25950]

Specialists don't take Medicaid because it costs them money to see patients. Here in sunny Florida, docs get paid, on average, about 60% of Medicare for Medicaid. Sorry, but that just isn't going to cover supplies, staff, rent, malpractice, and all the other overhead.

 

We need a single payer, I'm afraid.

[jmj11]

I give DHE 45 in the office. It cost me $85 for the 1 MG ampule, not to mention the time, the other supplies.  Medicare pays me $35 for the treatment.  In the laws they say they can never reimburse less than the actual cost of the drug. We then approached them with this statement in their policy and the receipt for the meds. They, in response, reported back that the drug cost $25.  We searched the whole country and found it for no less than $80 anywhere.  Their records for drug cost was updated in 1995 (when DHE 45 did cost $25).  They say there is nothing they can do because they are within their guidelines. 

[Guest Paula]

^^^^that is a reason government won't do a good job with health care. They are living under antiquated rules and too large to correct themselves

[Joelseff]

I give DHE 45 in the office. It cost me $85 for the 1 MG ampule, not to mention the time, the other supplies. Medicare pays me $35 for the treatment. In the laws they say they can never reimburse less than the actual cost of the drug. We then approached them with this statement in their policy and the receipt for the meds. They, in response, reported back that the drug cost $25. We searched the whole country and found it for no less than $80 anywhere. Their records for drug cost was updated in 1995 (when DHE 45 did cost $25). They say there is nothing they can do because they are within their guidelines.

Thats like having a lemonade stand that says "all you can drink for a nickel." Then the kid takes your money, pours you a cup and says "there, that's all you can drink for a nickel..."

 

Sent from my Galaxy S4 Active using Tapatalk.

 

[gleannfia]

But the ACA has a loophole which allows states to develop a single payer system if they meet certain criteria.  Vermont will begin such a system in 2017. Let's see how it works.  In Canada, Saskatchewan was the first province to enact such legislature, and when other provinces saw and liked it, insisted on it for their own.  Tommy Douglas, the political leader who first pushed for it, is revered to this day.

 

Look, I am not saying a single payer system would be the ultimate answer. Any system is going to have drawbacks.  Maybe we should go back to cash, as Paula suggested. My main contention is this:  the more we can remove Big In$urance from the health care delivery process, the better off we will be.  I would like to see them relegated to a supplementary role, as they are with Medicare. Or for things like cosmetic surgery, concierge care, extras. But Aetna et al are middlemen who serve no useful function.  They are parasites, who deny care to please their shareholders.  I think Wendell Potter's "Deadly Spin" should be required reading.  He is a former insurance executive who finally could not live with himself any longer and quit.  He details just how dirty these people are, and all of their deceptive practices.

 

And before anyone details rationing in other systems, please realize that ALL health care systems ration care, including the US.  It is just a matter of how.

[hlj25950]

But the ACA has a loophole which allows states to develop a single payer system if they meet certain criteria. Vermont will begin such a system in 2017. Let's see how it works. In Canada, Saskatchewan was the first province to enact such legislature, and when other provinces saw and liked it, insisted on it for their own. Tommy Douglas, the political leader who first pushed for it, is revered to this day.

 

Look, I am not saying a single payer system would be the ultimate answer. Any system is going to have drawbacks. Maybe we should go back to cash, as Paula suggested. My main contention is this: the more we can remove Big In$urance from the health care delivery process, the better off we will be. I would like to see them relegated to a supplementary role, as they are with Medicare. Or for things like cosmetic surgery, concierge care, extras. But Aetna et al are middlemen who serve no useful function. They are parasites, who deny care to please their shareholders. I think Wendell Potter's "Deadly Spin" should be required reading. He is a former insurance executive who finally could not live with himself any longer and quit. He details just how dirty these people are, and all of their deceptive practices.

 

And before anyone details rationing in other systems, please realize that ALL health care systems ration care, including the US. It is just a matter of how.

Here, here! Bravo!

[gleannfia]

Proud member of the Minnesota chapter.  They have some fabulous people.

[gleannfia]

So many people (mistakenly) equate Single Payer with socialized medicine.  It is not. Medicare operates with a much lower overhead and bureaucratic bloat than insurance.  Why do people tie themselves up in knots about who pays them?  As long as they actually do get paid.

[roombroker03]

Facilities, then again, are for the individuals who have the advantage of time and need to have something checked up ought to something trouble them restoratively.