Re: Spreading the word - pitfalls to avoid

[Guest guest]

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.

To: Sent: Wednesday, November 26, 2008 11:40:53 AMSubject: RE: 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: [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]

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 Coghill

Sent: Tuesday, December 02, 2008

5:56 AM

To:

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

<gmooreidealhealthnetwork>

To:

Sent: Wednesday, November 26, 2008

11:40:53 AM

Subject: RE:

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:

[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

On Nov 25, 2008,

at 11:29 AM, Brady, MD wrote:

[Guest guest]

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 Coghill

Sent: Tuesday, December 02, 2008

5:56 AM

To:

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

<gmooreidealhealthnetwork>

To:

Sent: Wednesday, November 26, 2008

11:40:53 AM

Subject: RE:

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:

[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

On Nov 25, 2008,

at 11:29 AM, Brady, MD wrote:

[Guest guest]

When we did them, we had a mix of patients--some who really wanted their PCP to do it, and some who preferred a gyn. This was fine when Alice had No Patients (when I started helping her) but after I got it built up, and we kept getting the 23year old non-virgin who had never had a pelvic before and was terrified and kept the exam room tied up for 90 minutes crying (OK, she is scared and I understand that. I even sympathise. But we are now 90 minutes behind schedule and people are complaining...), well.,.... And then there is the problem of having a decent MA that properly prepares the room (they just cant seem to get it straight!). And then,....well, the latest recommendation from MLMIC is that all doctors, regardless of gender, have and observer (prob. female) during this

exam. So new we had to look at hiring extra personnel. Just to perform this exam where you have to fight the insurance company and patient over payment (ins. companies want to include it in the annual physical. We insist on separate visit just as if going to a gyn). Poppycock!

When we stopped, our patient volume didn't drop (granted, we are in NYC so there's alot of potential patients) and we have a good relationship with a couple of gyns. They don't try to do primary care, and we don't do gyn. As one said " if its not below the waist, and its not the breast, go see your pcp. Don't have one, take this card, she's at the corner." Believe me, it was really baaaaaad. Alice is very empathetic (most doctors probably are) so she would really focus in on making the girl feel at ease and reassuring her, "there's nothng to be afraid of, only takes a minute, etc." And in the end, she would love us. But two other people got mad, left, and started disparaging us. And bad comments travel MUCH faster than good.

To: Sent: Friday, December 5, 2008 8:59:40 AMSubject: Re: Spreading the word - pitfalls to avoid

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

[Guest guest]

When we did them, we had a mix of patients--some who really wanted their PCP to do it, and some who preferred a gyn. This was fine when Alice had No Patients (when I started helping her) but after I got it built up, and we kept getting the 23year old non-virgin who had never had a pelvic before and was terrified and kept the exam room tied up for 90 minutes crying (OK, she is scared and I understand that. I even sympathise. But we are now 90 minutes behind schedule and people are complaining...), well.,.... And then there is the problem of having a decent MA that properly prepares the room (they just cant seem to get it straight!). And then,....well, the latest recommendation from MLMIC is that all doctors, regardless of gender, have and observer (prob. female) during this

exam. So new we had to look at hiring extra personnel. Just to perform this exam where you have to fight the insurance company and patient over payment (ins. companies want to include it in the annual physical. We insist on separate visit just as if going to a gyn). Poppycock!

When we stopped, our patient volume didn't drop (granted, we are in NYC so there's alot of potential patients) and we have a good relationship with a couple of gyns. They don't try to do primary care, and we don't do gyn. As one said " if its not below the waist, and its not the breast, go see your pcp. Don't have one, take this card, she's at the corner." Believe me, it was really baaaaaad. Alice is very empathetic (most doctors probably are) so she would really focus in on making the girl feel at ease and reassuring her, "there's nothng to be afraid of, only takes a minute, etc." And in the end, she would love us. But two other people got mad, left, and started disparaging us. And bad comments travel MUCH faster than good.

To: Sent: Friday, December 5, 2008 8:59:40 AMSubject: Re: Spreading the word - pitfalls to avoid

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

[Guest guest]

When we did them, we had a mix of patients--some who really wanted their PCP to do it, and some who preferred a gyn. This was fine when Alice had No Patients (when I started helping her) but after I got it built up, and we kept getting the 23year old non-virgin who had never had a pelvic before and was terrified and kept the exam room tied up for 90 minutes crying (OK, she is scared and I understand that. I even sympathise. But we are now 90 minutes behind schedule and people are complaining...), well.,.... And then there is the problem of having a decent MA that properly prepares the room (they just cant seem to get it straight!). And then,....well, the latest recommendation from MLMIC is that all doctors, regardless of gender, have and observer (prob. female) during this

exam. So new we had to look at hiring extra personnel. Just to perform this exam where you have to fight the insurance company and patient over payment (ins. companies want to include it in the annual physical. We insist on separate visit just as if going to a gyn). Poppycock!

When we stopped, our patient volume didn't drop (granted, we are in NYC so there's alot of potential patients) and we have a good relationship with a couple of gyns. They don't try to do primary care, and we don't do gyn. As one said " if its not below the waist, and its not the breast, go see your pcp. Don't have one, take this card, she's at the corner." Believe me, it was really baaaaaad. Alice is very empathetic (most doctors probably are) so she would really focus in on making the girl feel at ease and reassuring her, "there's nothng to be afraid of, only takes a minute, etc." And in the end, she would love us. But two other people got mad, left, and started disparaging us. And bad comments travel MUCH faster than good.

To: Sent: Friday, December 5, 2008 8:59:40 AMSubject: Re: Spreading the word - pitfalls to avoid

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