Re: Wall of shame documents

[Guest guest]

You meet many people here including docs and patients who are afraid of a single payer medical system. They always quote one scenario where someone got bad care in Canada. But look at King Drew hospital here in Los angeles. It had to close because people did not get timely care in ER and died in the waiting room. This was not just once. Many horror stories from this hospital in an undeserved area of Los Angeles. This is a medical system that those who are making lots of money on it support. Wonder how many people there are that benefit from this system? I would think a large percentage of the population. It includes Ins co and there share holders, big pharma and all their employees, specialists, DME contractors, etc. They don't want it to change. The other thing that would set up failure for a single payer in USA is attitude. The payer/ gov't needs to have the attitude that they want to system to work, they want to have pt get easy access, they want to have the physician be in charge and respect our judgement (rather than question everything we do), they want the pay the docs equally and fairly for same work done (presently we are paid by where we live as per medicare, the richer your neighbors, the more you get- logic of gov't to support the rich and shun the poor). it would have to be a supportive bureaucracy. Not like now. Now it seems they the purposely set up road blocks. Block us every step of the way. Thinking we, primary care, are the problem to the rising costs which in fact is completely wrong. Makes it so difficult. If a single payer were to work, they would have to let doctors organize and form a negotiating group to balance the power of the single payer. We need to have a voice. The attitude would have to change to supportive and make us feel loved (got that last comment from my Integrative Medicine course. Those who attended know what I mean).

Our present health care system feels more socialistic than in Canada, where majority of docs are self employed and their own boss. In America, everyone pays into this inefficient system that creates lots of bureacracy and clerical jobs. People pay lots of money into this big pot called premiums. Then a few companies control everything else that happens. Pts can't find docs who take their ins (because their ins pays so poorly, if at all). Pts have already paid a lot of money and then feel it is unfair for docs to charge them again, not knowing, we don't get paid fairly by their insurance co. for all the work we do.

Big business has all the power and we are the pawns. Need some sort of regulation to even out the power. In Canada the docs are allowed to organized and negotiates w the gov't in good faith. Also another difference between Canada and here: the Canadian gov't regulates lots of things in society. In USA, the regulation comes from the free market and lawyers. My explanation as to why we need so many lawyers in this country: the gov't tends to be hands off. In any society to work, we need checks and balances otherwise greed is a powerful driver and can take over. Look at what happened to the unregulated morgage industry...

Sorry for the long rant...

Wow, Gordon, I love it when passionate outrage sneaks in between the lines of one of your entries. I have often placed the calls for prior authorization from the examining room, with the patient listening-in, and the speaker-phone button pushed ... Patients do appreciate the effort, and share my disappointment when we get turned-down together (being required by the nurse in Atlanta, or St. Louis, to document that they failed to get good response to Neurontin, and that they had bad side effects from 2 different tricyclics for the neuropathic pain, before they would open the purse-strings to help them pay for the Lyrica which worked so well when the rheumatologist gave them some free samples ...). One day, the lady on the prior-authorization line realized that I was on speaker phone, and she insisted that I had to hang-up and call back on a different line, or she would hang-up on me. I tried to get her to bring her superviser to the phone, but he was in a meeting ... Oh, shucks. I am sure that the one-party-payor system in Canada has flaws, but this system is just rotten to the core.

The public is mostly unaware of how amazingly complex, time consuming, and trivial our work is when we're not in the room with them.

To help make the point, it is helpful to have on hand the policy documents you receive from insurers.

I love the 8.5x14 inch double sided documents from BCBS I used to receive inRochester NY telling me in 9pt type all the variations for co-payments. The co-pay varied based on the type of visit, the employer contract, and the type of plan(s) chosen by the employer.

I imagine a wall in each of our offices (waiting room wall would be good) that is papered over by the documentation requirements for prior authorization, the documentation requirements for CPT codes, the auto-rejected claims based on down-coding engines, the rejected claims. I imagine a collage showing how many times you have to re-submit to get paid a fraction, and what happens when a patient has Medicare primary and a supplemental insurance. We could paper an entirely different wall with all the formularies from the different insurers (make sure to point out that they get legal kickbacks from the pharmaceutical industry to steer their "members" to certain drugs.

Some other techniques I love:

Have the patient sit in the room with you as you try to obtain prior authorization. Make sure to do it on a speakerphone. One of my favorite anecdotes is a doc who asks the patient "Do you have a cell phone?" The doc then borrows the pt's cell to call the insurer & says "come get me in the next room when you get through the 'on hold' line." You could create a laminated sheet that tells patients how to "press 3 for …" etc.

Ask your patients to call the insurer to ask why a claim wasn't paid and come back with the answer.

Have a separate phone in the waiting room and ask your patients to verify their insurance status and check on the co-payment for every visit (like we're supposed to do).

Give your patient their list of recommended prescriptions and have them try to find on the web or phone if these meds are covered and at what co-pay and at what pharmacy.

As I type this list I sit back and think "gosh, this is starting to seem cruel." And then I think "IT IS CRUEL!!!!!" How can we keep up with this nonsense!?!? The public must be made aware that this is way beyond "annoying paperwork" and into the land of "we can't even get to our work for you because we're drowning in this insanity!"

We've had 20+ years of the experiment in managing "care" through price control, prior authorizations, formularies, case management, disease management. Many executives hold up graphs showing improved generic prescribing rates, improved cost of care of high illness burden patients, reduced A1c burden for patients with diabetes. These are good things, but have we seen an overall improvement in clinical outcomes, patient experience of care, total cost of care? We know all too well that proximate outcomes may not lead to the ultimate outcomes we need.

It is time to pull the plug on this experiment, it is hurting our patients, it is hurtingAmerica.

It is time to follow the data demonstrating the worth of effective primary care.

We need the resources to pursue our professional obligations for our patients.

Gordon

-- M.D.www.elainemd.com

Office: Go in the directions of your dreams and live the life you've imagined.

[Guest guest]

You meet many people here including docs and patients who are afraid of a single payer medical system. They always quote one scenario where someone got bad care in Canada. But look at King Drew hospital here in Los angeles. It had to close because people did not get timely care in ER and died in the waiting room. This was not just once. Many horror stories from this hospital in an undeserved area of Los Angeles. This is a medical system that those who are making lots of money on it support. Wonder how many people there are that benefit from this system? I would think a large percentage of the population. It includes Ins co and there share holders, big pharma and all their employees, specialists, DME contractors, etc. They don't want it to change. The other thing that would set up failure for a single payer in USA is attitude. The payer/ gov't needs to have the attitude that they want to system to work, they want to have pt get easy access, they want to have the physician be in charge and respect our judgement (rather than question everything we do), they want the pay the docs equally and fairly for same work done (presently we are paid by where we live as per medicare, the richer your neighbors, the more you get- logic of gov't to support the rich and shun the poor). it would have to be a supportive bureaucracy. Not like now. Now it seems they the purposely set up road blocks. Block us every step of the way. Thinking we, primary care, are the problem to the rising costs which in fact is completely wrong. Makes it so difficult. If a single payer were to work, they would have to let doctors organize and form a negotiating group to balance the power of the single payer. We need to have a voice. The attitude would have to change to supportive and make us feel loved (got that last comment from my Integrative Medicine course. Those who attended know what I mean).

Our present health care system feels more socialistic than in Canada, where majority of docs are self employed and their own boss. In America, everyone pays into this inefficient system that creates lots of bureacracy and clerical jobs. People pay lots of money into this big pot called premiums. Then a few companies control everything else that happens. Pts can't find docs who take their ins (because their ins pays so poorly, if at all). Pts have already paid a lot of money and then feel it is unfair for docs to charge them again, not knowing, we don't get paid fairly by their insurance co. for all the work we do.

Big business has all the power and we are the pawns. Need some sort of regulation to even out the power. In Canada the docs are allowed to organized and negotiates w the gov't in good faith. Also another difference between Canada and here: the Canadian gov't regulates lots of things in society. In USA, the regulation comes from the free market and lawyers. My explanation as to why we need so many lawyers in this country: the gov't tends to be hands off. In any society to work, we need checks and balances otherwise greed is a powerful driver and can take over. Look at what happened to the unregulated morgage industry...

Sorry for the long rant...

Wow, Gordon, I love it when passionate outrage sneaks in between the lines of one of your entries. I have often placed the calls for prior authorization from the examining room, with the patient listening-in, and the speaker-phone button pushed ... Patients do appreciate the effort, and share my disappointment when we get turned-down together (being required by the nurse in Atlanta, or St. Louis, to document that they failed to get good response to Neurontin, and that they had bad side effects from 2 different tricyclics for the neuropathic pain, before they would open the purse-strings to help them pay for the Lyrica which worked so well when the rheumatologist gave them some free samples ...). One day, the lady on the prior-authorization line realized that I was on speaker phone, and she insisted that I had to hang-up and call back on a different line, or she would hang-up on me. I tried to get her to bring her superviser to the phone, but he was in a meeting ... Oh, shucks. I am sure that the one-party-payor system in Canada has flaws, but this system is just rotten to the core.

The public is mostly unaware of how amazingly complex, time consuming, and trivial our work is when we're not in the room with them.

To help make the point, it is helpful to have on hand the policy documents you receive from insurers.

I love the 8.5x14 inch double sided documents from BCBS I used to receive inRochester NY telling me in 9pt type all the variations for co-payments. The co-pay varied based on the type of visit, the employer contract, and the type of plan(s) chosen by the employer.

I imagine a wall in each of our offices (waiting room wall would be good) that is papered over by the documentation requirements for prior authorization, the documentation requirements for CPT codes, the auto-rejected claims based on down-coding engines, the rejected claims. I imagine a collage showing how many times you have to re-submit to get paid a fraction, and what happens when a patient has Medicare primary and a supplemental insurance. We could paper an entirely different wall with all the formularies from the different insurers (make sure to point out that they get legal kickbacks from the pharmaceutical industry to steer their "members" to certain drugs.

Some other techniques I love:

Have the patient sit in the room with you as you try to obtain prior authorization. Make sure to do it on a speakerphone. One of my favorite anecdotes is a doc who asks the patient "Do you have a cell phone?" The doc then borrows the pt's cell to call the insurer & says "come get me in the next room when you get through the 'on hold' line." You could create a laminated sheet that tells patients how to "press 3 for …" etc.

Ask your patients to call the insurer to ask why a claim wasn't paid and come back with the answer.

Have a separate phone in the waiting room and ask your patients to verify their insurance status and check on the co-payment for every visit (like we're supposed to do).

Give your patient their list of recommended prescriptions and have them try to find on the web or phone if these meds are covered and at what co-pay and at what pharmacy.

As I type this list I sit back and think "gosh, this is starting to seem cruel." And then I think "IT IS CRUEL!!!!!" How can we keep up with this nonsense!?!? The public must be made aware that this is way beyond "annoying paperwork" and into the land of "we can't even get to our work for you because we're drowning in this insanity!"

We've had 20+ years of the experiment in managing "care" through price control, prior authorizations, formularies, case management, disease management. Many executives hold up graphs showing improved generic prescribing rates, improved cost of care of high illness burden patients, reduced A1c burden for patients with diabetes. These are good things, but have we seen an overall improvement in clinical outcomes, patient experience of care, total cost of care? We know all too well that proximate outcomes may not lead to the ultimate outcomes we need.

It is time to pull the plug on this experiment, it is hurting our patients, it is hurtingAmerica.

It is time to follow the data demonstrating the worth of effective primary care.

We need the resources to pursue our professional obligations for our patients.

Gordon

-- M.D.www.elainemd.com

Office: Go in the directions of your dreams and live the life you've imagined.

[Guest guest]

You meet many people here including docs and patients who are afraid of a single payer medical system. They always quote one scenario where someone got bad care in Canada. But look at King Drew hospital here in Los angeles. It had to close because people did not get timely care in ER and died in the waiting room. This was not just once. Many horror stories from this hospital in an undeserved area of Los Angeles. This is a medical system that those who are making lots of money on it support. Wonder how many people there are that benefit from this system? I would think a large percentage of the population. It includes Ins co and there share holders, big pharma and all their employees, specialists, DME contractors, etc. They don't want it to change. The other thing that would set up failure for a single payer in USA is attitude. The payer/ gov't needs to have the attitude that they want to system to work, they want to have pt get easy access, they want to have the physician be in charge and respect our judgement (rather than question everything we do), they want the pay the docs equally and fairly for same work done (presently we are paid by where we live as per medicare, the richer your neighbors, the more you get- logic of gov't to support the rich and shun the poor). it would have to be a supportive bureaucracy. Not like now. Now it seems they the purposely set up road blocks. Block us every step of the way. Thinking we, primary care, are the problem to the rising costs which in fact is completely wrong. Makes it so difficult. If a single payer were to work, they would have to let doctors organize and form a negotiating group to balance the power of the single payer. We need to have a voice. The attitude would have to change to supportive and make us feel loved (got that last comment from my Integrative Medicine course. Those who attended know what I mean).

Our present health care system feels more socialistic than in Canada, where majority of docs are self employed and their own boss. In America, everyone pays into this inefficient system that creates lots of bureacracy and clerical jobs. People pay lots of money into this big pot called premiums. Then a few companies control everything else that happens. Pts can't find docs who take their ins (because their ins pays so poorly, if at all). Pts have already paid a lot of money and then feel it is unfair for docs to charge them again, not knowing, we don't get paid fairly by their insurance co. for all the work we do.

Big business has all the power and we are the pawns. Need some sort of regulation to even out the power. In Canada the docs are allowed to organized and negotiates w the gov't in good faith. Also another difference between Canada and here: the Canadian gov't regulates lots of things in society. In USA, the regulation comes from the free market and lawyers. My explanation as to why we need so many lawyers in this country: the gov't tends to be hands off. In any society to work, we need checks and balances otherwise greed is a powerful driver and can take over. Look at what happened to the unregulated morgage industry...

Sorry for the long rant...

Wow, Gordon, I love it when passionate outrage sneaks in between the lines of one of your entries. I have often placed the calls for prior authorization from the examining room, with the patient listening-in, and the speaker-phone button pushed ... Patients do appreciate the effort, and share my disappointment when we get turned-down together (being required by the nurse in Atlanta, or St. Louis, to document that they failed to get good response to Neurontin, and that they had bad side effects from 2 different tricyclics for the neuropathic pain, before they would open the purse-strings to help them pay for the Lyrica which worked so well when the rheumatologist gave them some free samples ...). One day, the lady on the prior-authorization line realized that I was on speaker phone, and she insisted that I had to hang-up and call back on a different line, or she would hang-up on me. I tried to get her to bring her superviser to the phone, but he was in a meeting ... Oh, shucks. I am sure that the one-party-payor system in Canada has flaws, but this system is just rotten to the core.

The public is mostly unaware of how amazingly complex, time consuming, and trivial our work is when we're not in the room with them.

To help make the point, it is helpful to have on hand the policy documents you receive from insurers.

I love the 8.5x14 inch double sided documents from BCBS I used to receive inRochester NY telling me in 9pt type all the variations for co-payments. The co-pay varied based on the type of visit, the employer contract, and the type of plan(s) chosen by the employer.

I imagine a wall in each of our offices (waiting room wall would be good) that is papered over by the documentation requirements for prior authorization, the documentation requirements for CPT codes, the auto-rejected claims based on down-coding engines, the rejected claims. I imagine a collage showing how many times you have to re-submit to get paid a fraction, and what happens when a patient has Medicare primary and a supplemental insurance. We could paper an entirely different wall with all the formularies from the different insurers (make sure to point out that they get legal kickbacks from the pharmaceutical industry to steer their "members" to certain drugs.

Some other techniques I love:

Have the patient sit in the room with you as you try to obtain prior authorization. Make sure to do it on a speakerphone. One of my favorite anecdotes is a doc who asks the patient "Do you have a cell phone?" The doc then borrows the pt's cell to call the insurer & says "come get me in the next room when you get through the 'on hold' line." You could create a laminated sheet that tells patients how to "press 3 for …" etc.

Ask your patients to call the insurer to ask why a claim wasn't paid and come back with the answer.

Have a separate phone in the waiting room and ask your patients to verify their insurance status and check on the co-payment for every visit (like we're supposed to do).

Give your patient their list of recommended prescriptions and have them try to find on the web or phone if these meds are covered and at what co-pay and at what pharmacy.

As I type this list I sit back and think "gosh, this is starting to seem cruel." And then I think "IT IS CRUEL!!!!!" How can we keep up with this nonsense!?!? The public must be made aware that this is way beyond "annoying paperwork" and into the land of "we can't even get to our work for you because we're drowning in this insanity!"

We've had 20+ years of the experiment in managing "care" through price control, prior authorizations, formularies, case management, disease management. Many executives hold up graphs showing improved generic prescribing rates, improved cost of care of high illness burden patients, reduced A1c burden for patients with diabetes. These are good things, but have we seen an overall improvement in clinical outcomes, patient experience of care, total cost of care? We know all too well that proximate outcomes may not lead to the ultimate outcomes we need.

It is time to pull the plug on this experiment, it is hurting our patients, it is hurtingAmerica.

It is time to follow the data demonstrating the worth of effective primary care.

We need the resources to pursue our professional obligations for our patients.

Gordon

-- M.D.www.elainemd.com

Office: Go in the directions of your dreams and live the life you've imagined.