Re: Spreading the word - pitfalls to avoid

[Guest guest]

As others consider writing pieces for

their local paper I have some suggestions.

1: Don’t try to make a case

for improving PCP income.

I once made the point that there are some

amazingly altruistic docs out there making as little as $50K because of their

belief in doing the right thing. The audience take was not what I

expected: they said “Dang. $50K, that’s great. If only

I could make $50K, you docs are so rich.”

Physicians are in the top income bracket

in the US.

This is thin ice territory, especially with the current economy. After

much schooling, training, and often immense debt we provide a terrific service

in our profession, but now is not the time to argue about how much we are worth.

Discussions of PCP-specialist relative worth should take place in other venues

than mainstream media.

2: Do make the point that we kept

from really working for out patients by a blizzard of administrative trivia

that is supposed to help keep costs & premiums down but perversely make

things worse. We spend valuable time justifying our patient needs to

clerks and supervising staff to make sure the insurance companies actually pay

us according to their Byzantine rules.

The difference is subtle but very

important: income and payment arguments create a wedge between our patients and

us. Pointing out the immense wedge being driven into our relationship by misguided

efforts to save health care dollars is a better way to go. Then connect

the dots and show folks how the wedge in the relationship perversely leads to

increased cost as it bogs us down in trivia while keeping us from the work we

would rather be doing for our patients.

Gordon

From: [mailto: ] On Behalf Of Strazzullo

Sent: Tuesday, November 25, 2008

11:11 PM

To:

Subject: Re:

Spreading the word

Great

writing, . I can't wait to see the 3rd part. Smiley

Thankur's article seems to hit on a lot of the same points, though it's unusual

to see a specialist complaining about insurance reimbursement. It's

probably because he isn't procedurally oriented, though I assume he may do

biopsies. As Graham pointed out many of the comments to Smiley are

extremely negative and demonstrate that a lot of washingtonians who take the

time to blog don't understand the difference in income between specialties in

the US.

Straz

[Guest guest]

Good points, Gordon. I agree with what you say but it really pains me to see comments like these: "I don't know of any doctors that are trying to balance home and worklife. Usually, the doctor's dilemma is choosing between Jamaica and Belize for the next scuba vacation, or which to buy the Mrs. for Christmas: The Audi or the Lexus? Tough choices." "I will exchange income with you, Dr. Thakur. You seem to assume all patients can afford $200 to wait 3 hours in your waiting room. I think doctors lose touch with the real world, and don't realize that the middle class is extinct. I guess the good doctor wants just a handful of rich doctors to treat the handful of rich folksthat are left. ( my brother is an electrical contractor working on a $6 million dollar home for a physician. He says the majority of expensive homes are built by physicians. Look in the recorders office and see who owns most of the property in town-physicians or dentists.)" Sometimes, people need to see reality. StrazAs others consider writing pieces for their local paper I have some suggestions. 1: Don’t try to make a case for improving PCP income.I once made the point that there are some amazingly altruistic docs out there making as little as $50K because of their belief in doing the right thing. The audience take was not what I expected: they said “Dang. $50K, that’s great. If only I could make $50K, you docs are so rich.”Physicians are in the top income bracket in the US. This is thin ice territory, especially with the current economy. After much schooling, training, and often immense debt we provide a terrific service in our profession, but now is not the time to argue about how much we are worth. Discussions of PCP-specialist relative worth should take place in other venues than mainstream media. 2: Do make the point that we kept from really working for out patients by a blizzard of administrative trivia that is supposed to help keep costs & premiums down but perversely make things worse. We spend valuable time justifying our patient needs to clerks and supervising staff to make sure the insurance companies actually pay us according to their Byzantine rules. The difference is subtle but very important: income and payment arguments create a wedge between our patients and us. Pointing out the immense wedge being driven into our relationship by misguided efforts to save health care dollars is a better way to go. Then connect the dots and show folks how the wedge in the relationship perversely leads to increased cost as it bogs us down in trivia while keeping us from the work we would rather be doing for our patients.GordonFrom: [mailto: ] On Behalf Of StrazzulloSent: Tuesday, November 25, 2008 11:11 PMTo: Subject: Re: Spreading the word Great writing, . I can't wait to see the 3rd part. Smiley Thankur's article seems to hit on a lot of the same points, though it's unusual to see a specialist complaining about insurance reimbursement. It's probably because he isn't procedurally oriented, though I assume he may do biopsies. As Graham pointed out many of the comments to Smiley are extremely negative and demonstrate that a lot of washingtonians who take the time to blog don't understand the difference in income between specialties in the US. Straz

[Guest guest]

[Guest guest]

See, here they don't bother to downcode to pay you less because they pay you the same regardless of the length or complexity of the visit. 99215? $35 (or is it $30).

To: Sent: Tuesday, December 2, 2008 4:23:10 PMSubject: RE: Spreading the word - pitfalls to avoid

On the flip side, we get patients that say “How come you bill so much when you only get paid $56?”

We dropped Medicaid when they started downcoding all of our level 4 exams to a level 3 and then paid us $24. These were our sickest patients, appealed and denied and now have to seek care from the Medi-Cal clinic 20 miles away.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

Roy Medical Associates, Inc.

From: [mailto: ] On Behalf Of Wayne CoghillSent: Tuesday, December 02, 2008 5:56 AMTo: Subject: Re: Spreading the word - pitfalls to avoid

I understand that some people think that $50K is "rich." But honestly, not even most poor people really believe that. For the past 20 yrs, it hasn't been the right time to talk about how much PCPs are worth. Come hell or high water, you guys need to start talking about it publicly, economy be damned.

We had two patients actually tell us we need to be paid more.

1) "There must be some kind of mistake. My EOB says they only paid you $56! You must not be filing the claim right." This was from a Medicare patient. We just stopped taking Medicare.

2)"You billed them $100 and they paid you $35! No wonder you dropped it..." This is from a Medicaid patient. We just dropped them too.

Too bad only 2 said this.

From: L. Gordon < gmoore@idealhealthn etwork.com >To: Practiceimprovement 1yahoogroups (DOT) comSent: Wednesday, November 26, 2008 11:40:53 AMSubject: RE: [Practiceimprovemen t1] Spreading the word - pitfalls to avoid

As others consider writing pieces for their local paper I have some suggestions.

1: Don’t try to make a case for improving PCP income.

I once made the point that there are some amazingly altruistic docs out there making as little as $50K because of their belief in doing the right thing. The audience take was not what I expected: they said “Dang. $50K, that’s great. If only I could make $50K, you docs are so rich.”

Physicians are in the top income bracket in the US . This is thin ice territory, especially with the current economy. After much schooling, training, and often immense debt we provide a terrific service in our profession, but now is not the time to argue about how much we are worth. Discussions of PCP-specialist relative worth should take place in other venues than mainstream media.

2: Do make the point that we kept from really working for out patients by a blizzard of administrative trivia that is supposed to help keep costs & premiums down but perversely make things worse. We spend valuable time justifying our patient needs to clerks and supervising staff to make sure the insurance companies actually pay us according to their Byzantine rules.

The difference is subtle but very important: income and payment arguments create a wedge between our patients and us. Pointing out the immense wedge being driven into our relationship by misguided efforts to save health care dollars is a better way to go. Then connect the dots and show folks how the wedge in the relationship perversely leads to increased cost as it bogs us down in trivia while keeping us from the work we would rather be doing for our patients.

Gordon

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of StrazzulloSent: Tuesday, November 25, 2008 11:11 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Spreading the word

Great writing, . I can't wait to see the 3rd part. Smiley Thankur's article seems to hit on a lot of the same points, though it's unusual to see a specialist complaining about insurance reimbursement. It's probably because he isn't procedurally oriented, though I assume he may do biopsies. As Graham pointed out many of the comments to Smiley are extremely negative and demonstrate that a lot of washingtonians who take the time to blog don't understand the difference in income between specialties in the US .

Straz

[Guest guest]

See, here they don't bother to downcode to pay you less because they pay you the same regardless of the length or complexity of the visit. 99215? $35 (or is it $30).

To: Sent: Tuesday, December 2, 2008 4:23:10 PMSubject: RE: Spreading the word - pitfalls to avoid

On the flip side, we get patients that say “How come you bill so much when you only get paid $56?”

We dropped Medicaid when they started downcoding all of our level 4 exams to a level 3 and then paid us $24. These were our sickest patients, appealed and denied and now have to seek care from the Medi-Cal clinic 20 miles away.

Pratt

Office Manager

Oak Tree Internal Medicine P.C

Roy Medical Associates, Inc.

From: [mailto: ] On Behalf Of Wayne CoghillSent: Tuesday, December 02, 2008 5:56 AMTo: Subject: Re: Spreading the word - pitfalls to avoid

I understand that some people think that $50K is "rich." But honestly, not even most poor people really believe that. For the past 20 yrs, it hasn't been the right time to talk about how much PCPs are worth. Come hell or high water, you guys need to start talking about it publicly, economy be damned.

We had two patients actually tell us we need to be paid more.

1) "There must be some kind of mistake. My EOB says they only paid you $56! You must not be filing the claim right." This was from a Medicare patient. We just stopped taking Medicare.

2)"You billed them $100 and they paid you $35! No wonder you dropped it..." This is from a Medicaid patient. We just dropped them too.

Too bad only 2 said this.

From: L. Gordon < gmoore@idealhealthn etwork.com >To: Practiceimprovement 1yahoogroups (DOT) comSent: Wednesday, November 26, 2008 11:40:53 AMSubject: RE: [Practiceimprovemen t1] Spreading the word - pitfalls to avoid

As others consider writing pieces for their local paper I have some suggestions.

1: Don’t try to make a case for improving PCP income.

I once made the point that there are some amazingly altruistic docs out there making as little as $50K because of their belief in doing the right thing. The audience take was not what I expected: they said “Dang. $50K, that’s great. If only I could make $50K, you docs are so rich.”

Physicians are in the top income bracket in the US . This is thin ice territory, especially with the current economy. After much schooling, training, and often immense debt we provide a terrific service in our profession, but now is not the time to argue about how much we are worth. Discussions of PCP-specialist relative worth should take place in other venues than mainstream media.

2: Do make the point that we kept from really working for out patients by a blizzard of administrative trivia that is supposed to help keep costs & premiums down but perversely make things worse. We spend valuable time justifying our patient needs to clerks and supervising staff to make sure the insurance companies actually pay us according to their Byzantine rules.

The difference is subtle but very important: income and payment arguments create a wedge between our patients and us. Pointing out the immense wedge being driven into our relationship by misguided efforts to save health care dollars is a better way to go. Then connect the dots and show folks how the wedge in the relationship perversely leads to increased cost as it bogs us down in trivia while keeping us from the work we would rather be doing for our patients.

Gordon

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of StrazzulloSent: Tuesday, November 25, 2008 11:11 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Spreading the word

Great writing, . I can't wait to see the 3rd part. Smiley Thankur's article seems to hit on a lot of the same points, though it's unusual to see a specialist complaining about insurance reimbursement. It's probably because he isn't procedurally oriented, though I assume he may do biopsies. As Graham pointed out many of the comments to Smiley are extremely negative and demonstrate that a lot of washingtonians who take the time to blog don't understand the difference in income between specialties in the US .

Straz

[Guest guest]

Medicaid reimbursement for all levels of office visits in NY is

$30. Thank goodness I don't have to take it (plenty of large

hospital-based clinics nearby that do).---Sharlene---

>  

>

[Guest guest]

Medicaid reimbursement for all levels of office visits in NY is

$30. Thank goodness I don't have to take it (plenty of large

hospital-based clinics nearby that do).---Sharlene---

>  

>

[Guest guest]

Medicaid reimbursement for all levels of office visits in NY is

$30. Thank goodness I don't have to take it (plenty of large

hospital-based clinics nearby that do).---Sharlene---

>  

>

[Guest guest]

Agree that talking up income is thin ice and must be approached

carefully. However, especially in one-on-one contact, I don't think

that it should be avoided completely. It appears that it will take

Congressional action to shift needed resources to primary care, and

that won't happen if only primary care doctors are pushing for it.

Locally for me, where there is a primary care shortage, talking about

the reasons for the shortage seems to resonate with many folks. And

many can make the connection that this is largely due to the income

disparity. They know what I get for an hour's work versus what the

colonoscopist gets for an hour's work. And helping connect the dots

can raise awareness.

Haresch

>

> As others consider writing pieces for their local paper I have some

> suggestions.

>

>

>

> 1: Don't try to make a case for improving PCP income.

>

> I once made the point that there are some amazingly altruistic docs out

> there making as little as $50K because of their belief in doing the

right

> thing. The audience take was not what I expected: they said " Dang.

$50K,

> that's great. If only I could make $50K, you docs are so rich. "

>

> Physicians are in the top income bracket in the US. This is thin ice

> territory, especially with the current economy. After much schooling,

> training, and often immense debt we provide a terrific service in our

> profession, but now is not the time to argue about how much we are

worth.

> Discussions of PCP-specialist relative worth should take place in other

> venues than mainstream media.

>

>

>

> 2: Do make the point that we kept from really working for out

patients by a

> blizzard of administrative trivia that is supposed to help keep costs &

> premiums down but perversely make things worse. We spend valuable time

> justifying our patient needs to clerks and supervising staff to make

sure

> the insurance companies actually pay us according to their Byzantine

rules.

>

>

>

> The difference is subtle but very important: income and payment

arguments

> create a wedge between our patients and us. Pointing out the

immense wedge

> being driven into our relationship by misguided efforts to save

health care

> dollars is a better way to go. Then connect the dots and show folks

how the

> wedge in the relationship perversely leads to increased cost as it

bogs us

> down in trivia while keeping us from the work we would rather be

doing for

> our patients.

>

> Gordon

[Guest guest]

Agree that talking up income is thin ice and must be approached

carefully. However, especially in one-on-one contact, I don't think

that it should be avoided completely. It appears that it will take

Congressional action to shift needed resources to primary care, and

that won't happen if only primary care doctors are pushing for it.

Locally for me, where there is a primary care shortage, talking about

the reasons for the shortage seems to resonate with many folks. And

many can make the connection that this is largely due to the income

disparity. They know what I get for an hour's work versus what the

colonoscopist gets for an hour's work. And helping connect the dots

can raise awareness.

Haresch

>

> As others consider writing pieces for their local paper I have some

> suggestions.

>

>

>

> 1: Don't try to make a case for improving PCP income.

>

> I once made the point that there are some amazingly altruistic docs out

> there making as little as $50K because of their belief in doing the

right

> thing. The audience take was not what I expected: they said " Dang.

$50K,

> that's great. If only I could make $50K, you docs are so rich. "

>

> Physicians are in the top income bracket in the US. This is thin ice

> territory, especially with the current economy. After much schooling,

> training, and often immense debt we provide a terrific service in our

> profession, but now is not the time to argue about how much we are

worth.

> Discussions of PCP-specialist relative worth should take place in other

> venues than mainstream media.

>

>

>

> 2: Do make the point that we kept from really working for out

patients by a

> blizzard of administrative trivia that is supposed to help keep costs &

> premiums down but perversely make things worse. We spend valuable time

> justifying our patient needs to clerks and supervising staff to make

sure

> the insurance companies actually pay us according to their Byzantine

rules.

>

>

>

> The difference is subtle but very important: income and payment

arguments

> create a wedge between our patients and us. Pointing out the

immense wedge

> being driven into our relationship by misguided efforts to save

health care

> dollars is a better way to go. Then connect the dots and show folks

how the

> wedge in the relationship perversely leads to increased cost as it

bogs us

> down in trivia while keeping us from the work we would rather be

doing for

> our patients.

>

> Gordon

[Guest guest]

Agree that talking up income is thin ice and must be approached

carefully. However, especially in one-on-one contact, I don't think

that it should be avoided completely. It appears that it will take

Congressional action to shift needed resources to primary care, and

that won't happen if only primary care doctors are pushing for it.

Locally for me, where there is a primary care shortage, talking about

the reasons for the shortage seems to resonate with many folks. And

many can make the connection that this is largely due to the income

disparity. They know what I get for an hour's work versus what the

colonoscopist gets for an hour's work. And helping connect the dots

can raise awareness.

Haresch

>

> As others consider writing pieces for their local paper I have some

> suggestions.

>

>

>

> 1: Don't try to make a case for improving PCP income.

>

> I once made the point that there are some amazingly altruistic docs out

> there making as little as $50K because of their belief in doing the

right

> thing. The audience take was not what I expected: they said " Dang.

$50K,

> that's great. If only I could make $50K, you docs are so rich. "

>

> Physicians are in the top income bracket in the US. This is thin ice

> territory, especially with the current economy. After much schooling,

> training, and often immense debt we provide a terrific service in our

> profession, but now is not the time to argue about how much we are

worth.

> Discussions of PCP-specialist relative worth should take place in other

> venues than mainstream media.

>

>

>

> 2: Do make the point that we kept from really working for out

patients by a

> blizzard of administrative trivia that is supposed to help keep costs &

> premiums down but perversely make things worse. We spend valuable time

> justifying our patient needs to clerks and supervising staff to make

sure

> the insurance companies actually pay us according to their Byzantine

rules.

>

>

>

> The difference is subtle but very important: income and payment

arguments

> create a wedge between our patients and us. Pointing out the

immense wedge

> being driven into our relationship by misguided efforts to save

health care

> dollars is a better way to go. Then connect the dots and show folks

how the

> wedge in the relationship perversely leads to increased cost as it

bogs us

> down in trivia while keeping us from the work we would rather be

doing for

> our patients.

>

> Gordon

[Guest guest]

Not do GYN exams?!?! Wayne! I do 7-8 a week, my patients really prefer I do them. But, OK, it's not for everyone, you ARE right...

To: Sent: Tuesday, December 2, 2008 8:55:59 AMSubject: Re: Spreading the word - pitfalls to avoid

I understand that some people think that $50K is "rich." But honestly, not even most poor people really believe that. For the past 20 yrs, it hasn't been the right time to talk about how much PCPs are worth. Come hell or high water, you guys need to start talking about it publicly, economy be damned.

We had two patients actually tell us we need to be paid more.

1) "There must be some kind of mistake. My EOB says they only paid you $56! You must not be filing the claim right." This was from a Medicare patient. We just stopped taking Medicare.

2)"You billed them $100 and they paid you $35! No wonder you dropped it..." This is from a Medicaid patient. We just dropped them too.

Too bad only 2 said this.

From: L. Gordon <gmoore@idealhealthn etwork.com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Wednesday, November 26, 2008 11:40:53 AMSubject: RE: [Practiceimprovemen t1] Spreading the word - pitfalls to avoid

As others consider writing pieces for their local paper I have some suggestions.

1: Don’t try to make a case for improving PCP income.

I once made the point that there are some amazingly altruistic docs out there making as little as $50K because of their belief in doing the right thing. The audience take was not what I expected: they said “Dang. $50K, that’s great. If only I could make $50K, you docs are so rich.”

Physicians are in the top income bracket in the US . This is thin ice territory, especially with the current economy. After much schooling, training, and often immense debt we provide a terrific service in our profession, but now is not the time to argue about how much we are worth. Discussions of PCP-specialist relative worth should take place in other venues than mainstream media.

2: Do make the point that we kept from really working for out patients by a blizzard of administrative trivia that is supposed to help keep costs & premiums down but perversely make things worse. We spend valuable time justifying our patient needs to clerks and supervising staff to make sure the insurance companies actually pay us according to their Byzantine rules.

The difference is subtle but very important: income and payment arguments create a wedge between our patients and us. Pointing out the immense wedge being driven into our relationship by misguided efforts to save health care dollars is a better way to go. Then connect the dots and show folks how the wedge in the relationship perversely leads to increased cost as it bogs us down in trivia while keeping us from the work we would rather be doing for our patients.

Gordon

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of StrazzulloSent: Tuesday, November 25, 2008 11:11 PMTo: Practiceimprovement 1yahoogroups (DOT) comSubject: Re: [Practiceimprovemen t1] Spreading the word

Great writing, . I can't wait to see the 3rd part. Smiley Thankur's article seems to hit on a lot of the same points, though it's unusual to see a specialist complaining about insurance reimbursement. It's probably because he isn't procedurally oriented, though I assume he may do biopsies. As Graham pointed out many of the comments to Smiley are extremely negative and demonstrate that a lot of washingtonians who take the time to blog don't understand the difference in income between specialties in the US .

Straz