Re: Need help: Wording: Working from within.

[Guest guest]

Okay, so the Health Expert from DeFazio's office has asked me to send her a letter asking for DeFazio to get the OIG to accept low cost (40 - 50 dollars a month per family or possibly for a certain number of visits) concierge systems for uninsured and underinsured families and to say so in so many words. I am going to ask for him to get a letter from the OIG to specifically exclude these systems from prosecution as fraud against Medicare, taking into consideration there are a large number of recently unemployed and recently uninsured famlies who will not have access to primary care or continuity of care if we can not come up with an alternative system that also allows physicians to accept Medicare. I am currently working on the wording. I am asking for ideas from any of you

who have some good way to say this.

Thanks, Carla, for getting the June 18, 2007 Federal Register documentation for me so I could quote it to his office staff.

Joanne Holland DVM/MD Drain, Oregon

Joanne Holland DVM/MD

I have been thinking about this too. There are many factories closing or drastically cutting back nearby (RV industry). I now have more patients without insurance and expect it to get worse. I am usually off (haha, doing paperwork) on Thursdays and thought..... ......could I offer walk in appts for 2-3 hours, just on Thursdays -->one problem only $35........" Thrifty Thursdays"! I Date: Monday, November 24, 2008, 5:47 PM

From: joanne holland <joandvmmdyahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Monday, November 24, 2008 3:01:04 PMSubject: Re: [Practiceimprovemen t1] Need help. Working from within.

Dear Dr Levin,

You think the accepted RBRVS has to do with total reimbursment and income?

Ha.

I am working in rural Oregon, with what is humerously called an underserved community. There is little insurance here so when half of the insured people lose their jobs it is a really big deal. I suppose I could move to a wealthy suburb and open shop and not notice the economy..... for a while.

A third of my patients have no insurance (including the guy who lives under the covered bridge, the guy in the 5th wheel on Main street, and the little lady who bought a bit of land in the 1960s and lives in the brush up there in a tent.)

A third of my patients are Medicare or Medicaid.

The third of my patients that had insurance: half of them had high deductable while they were insured until last week when the mills closed throughout Oregon, and the mines closed in Southern and Eastern Oregon. By the by, also the steel mill in Portland closed, and many small businesses are closing: this week two print shops in Eugene, one of them a hundred years old closed leaving 160 people out of work, three large resturants in Eugene closed leaving over 100 other people, and the custom bus maker is laying off many of its workers. Most small business can not go without money for three to six months.

This is not a small problem: if you have not got to it yet in your community, well, you will. The reason these places are closing down is: no loans means no construction means the lumber industry is overstocked. The sawmills are closing. That means no product for the plywood, sawdust and other timber byproduct industries to work with, so the other business are laying off, closing or a few of them are cutting back to 2 or 3 days a week. The problem with these things closing is that other related industries will also fold because of no raw materials to work with, and service industries require an employed and financially sound population to keep functioning. Some of tthese plants will never reopen easily because the only people with money are Asian, and some plants have been sold to them; they are gutting the

equipment and taking it to Asia as we speak. Our business leaders assumed that when we had a global market they would control it....that is a questionable assumption.

I am trying to find a way to legally take care of these unemployed and newly uninsured patients. Here, it is about half the previously insured patient load. The only ones locally keeping their coverage are workers in the schools, and the lamination plant in town which is not closed yet. We low overhead practices are going to be way ahead of the game, if the economy does what some are saying it will do, as the high overhead practices will not be able to function with patient coverages like this.

Joanne Holland DVM/MD Drain, Oregon

Re: [Practiceimprovemen t1] Need help. Working from within.

From Drain,

So I contacted my congressman' s office, (Defazio) about finding a way to get a local exception to the regulation limiting the pricing of office visits to the medicare amounts, and forbidding us to have retainer practices for smaller amounts if we are also taking medicare. I put it to them that as of this week we have now had all the mills in Southern Oregon close, all the mines in Southern Oregon close, that 60% of my town's previously employed people are not now employed and that these uninsured are going to flood the single sliding scale federally funded clinic thirty miles away in Roseburg beyond capacity.

The congressman' s office has agreed to help facilitate this, particularly aiming at underserved areas.

My memory is that there were one or two small exception practices that were allowed to do this kind of thing after they went to court, but it has been months since I read about them. Does anyone know to whom you would apply and how in order to get such an exception? They need a direction to work on.

Gordon?

Joanne Hollane DVM/MD Drain, Oregon. -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

-- Annie SkaggsLexington, KY

[Guest guest]

JoAnne, I' don't know any insurance companies that will pay in full at time of service, so I would think that wording might help (as long as you follow through consistently). We're looking into a program called SimpleCare (I think), that would give us the structure I believe we need to be consistent about it in our own practice. I commend your efforts, and look forward to seeing where you go with this.

Sujay

I have been thinking about this too. There are many factories closing or drastically cutting back nearby (RV industry). I now have more patients without insurance and expect it to get worse. I am usually off (haha, doing paperwork) on Thursdays and thought..... ......could I offer walk in appts for 2-3 hours, just on Thursdays -->one problem only $35........" Thrifty Thursdays"! I Date: Monday, November 24, 2008, 5:47 PM

From: joanne holland <joandvmmdyahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Monday, November 24, 2008 3:01:04 PMSubject: Re: [Practiceimprovemen t1] Need help. Working from within.

Dear Dr Levin,

You think the accepted RBRVS has to do with total reimbursment and income?

Ha.

I am working in rural Oregon, with what is humerously called an underserved community. There is little insurance here so when half of the insured people lose their jobs it is a really big deal. I suppose I could move to a wealthy suburb and open shop and not notice the economy..... for a while.

A third of my patients have no insurance (including the guy who lives under the covered bridge, the guy in the 5th wheel on Main street, and the little lady who bought a bit of land in the 1960s and lives in the brush up there in a tent.)

A third of my patients are Medicare or Medicaid.

The third of my patients that had insurance: half of them had high deductable while they were insured until last week when the mills closed throughout Oregon, and the mines closed in Southern and Eastern Oregon. By the by, also the steel mill in Portland closed, and many small businesses are closing: this week two print shops in Eugene, one of them a hundred years old closed leaving 160 people out of work, three large resturants in Eugene closed leaving over 100 other people, and the custom bus maker is laying off many of its workers. Most small business can not go without money for three to six months.

This is not a small problem: if you have not got to it yet in your community, well, you will. The reason these places are closing down is: no loans means no construction means the lumber industry is overstocked. The sawmills are closing. That means no product for the plywood, sawdust and other timber byproduct industries to work with, so the other business are laying off, closing or a few of them are cutting back to 2 or 3 days a week. The problem with these things closing is that other related industries will also fold because of no raw materials to work with, and service industries require an employed and financially sound population to keep functioning. Some of tthese plants will never reopen easily because the only people with money are Asian, and some plants have been sold to them; they are gutting the

equipment and taking it to Asia as we speak. Our business leaders assumed that when we had a global market they would control it....that is a questionable assumption.

I am trying to find a way to legally take care of these unemployed and newly uninsured patients. Here, it is about half the previously insured patient load. The only ones locally keeping their coverage are workers in the schools, and the lamination plant in town which is not closed yet. We low overhead practices are going to be way ahead of the game, if the economy does what some are saying it will do, as the high overhead practices will not be able to function with patient coverages like this.

Joanne Holland DVM/MD Drain, Oregon

Re: [Practiceimprovemen t1] Need help. Working from within.

From Drain,

So I contacted my congressman' s office, (Defazio) about finding a way to get a local exception to the regulation limiting the pricing of office visits to the medicare amounts, and forbidding us to have retainer practices for smaller amounts if we are also taking medicare. I put it to them that as of this week we have now had all the mills in Southern Oregon close, all the mines in Southern Oregon close, that 60% of my town's previously employed people are not now employed and that these uninsured are going to flood the single sliding scale federally funded clinic thirty miles away in Roseburg beyond capacity.

The congressman' s office has agreed to help facilitate this, particularly aiming at underserved areas.

My memory is that there were one or two small exception practices that were allowed to do this kind of thing after they went to court, but it has been months since I read about them. Does anyone know to whom you would apply and how in order to get such an exception? They need a direction to work on.

Gordon?

Joanne Hollane DVM/MD Drain, Oregon. -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

-- Annie SkaggsLexington, KY

[Guest guest]

A concierge system implies that the monthly fee is paid ahead of time, prior to the time covered. Do any insurance companies or medicare pay ahead of time? Just a thought. StrazJoAnne, I' don't know any insurance companies that will pay in full at time of service, so I would think that wording might help (as long as you follow through consistently). We're looking into a program called SimpleCare (I think), that would give us the structure I believe we need to be consistent about it in our own practice. I commend your efforts, and look forward to seeing where you go with this. SujayI have been thinking about this too. There are many factories closing or drastically cutting back nearby (RV industry). I now have more patients without insurance and expect it to get worse. I am usually off (haha, doing paperwork) on Thursdays and thought..... ......could I offer walk in appts for 2-3 hours, just on Thursdays -->one problem only $35........" Thrifty Thursdays"! I Date: Monday, November 24, 2008, 5:47 PM From: joanne holland <joandvmmdyahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Monday, November 24, 2008 3:01:04 PMSubject: Re: [Practiceimprovemen t1] Need help. Working from within.Dear Dr Levin, You think the accepted RBRVS has to do with total reimbursment and income? Ha. I am working in rural Oregon, with what is humerously called an underserved community. There is little insurance here so when half of the insured people lose their jobs it is a really big deal. I suppose I could move to a wealthy suburb and open shop and not notice the economy..... for a while. A third of my patients have no insurance (including the guy who lives under the covered bridge, the guy in the 5th wheel on Main street, and the little lady who bought a bit of land in the 1960s and lives in the brush up there in a tent.) A third of my patients are Medicare or Medicaid. The third of my patients that had insurance: half of them had high deductable while they were insured until last week when the mills closed throughout Oregon, and the mines closed in Southern and Eastern Oregon. By the by, also the steel mill in Portland closed, and many small businesses are closing: this week two print shops in Eugene, one of them a hundred years old closed leaving 160 people out of work, three large resturants in Eugene closed leaving over 100 other people, and the custom bus maker is laying off many of its workers. Most small business can not go without money for three to six months. This is not a small problem: if you have not got to it yet in your community, well, you will. The reason these places are closing down is: no loans means no construction means the lumber industry is overstocked. The sawmills are closing. That means no product for the plywood, sawdust and other timber byproduct industries to work with, so the other business are laying off, closing or a few of them are cutting back to 2 or 3 days a week. The problem with these things closing is that other related industries will also fold because of no raw materials to work with, and service industries require an employed and financially sound population to keep functioning. Some of tthese plants will never reopen easily because the only people with money are Asian, and some plants have been sold to them; they are gutting the equipment and taking it to Asia as we speak. Our business leaders assumed that when we had a global market they would control it....that is a questionable assumption. I am trying to find a way to legally take care of these unemployed and newly uninsured patients. Here, it is about half the previously insured patient load. The only ones locally keeping their coverage are workers in the schools, and the lamination plant in town which is not closed yet. We low overhead practices are going to be way ahead of the game, if the economy does what some are saying it will do, as the high overhead practices will not be able to function with patient coverages like this. Joanne Holland DVM/MD Drain, Oregon Re: [Practiceimprovemen t1] Need help. Working from within. From Drain, So I contacted my congressman' s office, (Defazio) about finding a way to get a local exception to the regulation limiting the pricing of office visits to the medicare amounts, and forbidding us to have retainer practices for smaller amounts if we are also taking medicare. I put it to them that as of this week we have now had all the mills in Southern Oregon close, all the mines in Southern Oregon close, that 60% of my town's previously employed people are not now employed and that these uninsured are going to flood the single sliding scale federally funded clinic thirty miles away in Roseburg beyond capacity. The congressman' s office has agreed to help facilitate this, particularly aiming at underserved areas. My memory is that there were one or two small exception practices that were allowed to do this kind of thing after they went to court, but it has been months since I read about them. Does anyone know to whom you would apply and how in order to get such an exception? They need a direction to work on. Gordon? Joanne Hollane DVM/MD Drain, Oregon. -- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax -- Annie SkaggsLexington, KY