Re: Doctors going out of business

January 5, 2012

Our business manager and I were interviewed by this same reporter this morning. We'll see how her next article turns out.

On cnn page today. I cant even imagine having expenses of 1.5 mil per month. I had no idea that is how oncology works.

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3

g

January 5, 2012

What did you tell her?

WK

From: Pierce

Sent: Thursday, January 05, 2012 3:00 PM

To:

Subject: Re: Doctors going out of business

Our business manager and I were interviewed by this same reporter this morning. We'll see how her next article turns out.

On cnn page today. I cant even imagine having expenses of 1.5 mil per month. I had no idea that is how oncology works.

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3

g

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com=======

January 6, 2012

She initially asked a lot of questions about whether or how often we needed to take out loans to meet payroll. Did we use SBA loans? How many staff did we employ per physician? etc. She was very interested in how many physicians in our county had quit or gone employed (all primary care docs here except us and one solo internist). She also was interested in my partner's 1/2 cash practice.

After I spoke with her she spent 45 min. on the phone with my business manager. We both stressed the fact that we're doing very well at the moment but that primary care is fragile and SGR and the payments not keeping up with costs are forcing us to consider dropping Medicare and other third party payers entirely. We also stress our view that independent >> employed.

Who knows how she'll use our quotes. That's the risk with talking to reporters but I did like her first article.Her next article should come out in a few days.

What did you tell her?

WK

From: Pierce

Sent: Thursday, January 05, 2012 3:00 PM

To:

Subject: Re: Doctors going out of business

Our business manager and I were interviewed by this same reporter this morning. We'll see how her next article turns out.

On cnn page today. I cant even imagine having expenses of 1.5 mil per month. I had no idea that is how oncology works.

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3

g

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com

=======

January 9, 2012

,Let us know when the article comes out.Would you and your partner doing the community supported practice being willing to share the story on an IMP call?

SharonSharon McCoy MDRenaissance Family Medicine

10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com

She initially asked a lot of questions about whether or how often we needed to take out loans to meet payroll. Did we use SBA loans? How many staff did we employ per physician? etc. She was very interested in how many physicians in our county had quit or gone employed (all primary care docs here except us and one solo internist). She also was interested in my partner's 1/2 cash practice.

After I spoke with her she spent 45 min. on the phone with my business manager. We both stressed the fact that we're doing very well at the moment but that primary care is fragile and SGR and the payments not keeping up with costs are forcing us to consider dropping Medicare and other third party payers entirely. We also stress our view that independent >> employed.

Who knows how she'll use our quotes. That's the risk with talking to reporters but I did like her first article.Her next article should come out in a few days.

What did you tell her?

WK

From: Pierce

Sent: Thursday, January 05, 2012 3:00 PM

To:

Subject: Re: Doctors going out of business

Our business manager and I were interviewed by this same reporter this morning. We'll see how her next article turns out.

On cnn page today. I cant even imagine having expenses of 1.5 mil per month. I had no idea that is how oncology works.

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3

g

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com

=======

January 9, 2012

Here's the article:http://money.cnn.com/galleries/2012/smallbusiness/1201/gallery.doctors-broke/index.html?section=money_smbusiness

The tone is more grim than I would prefer. She spoke with and I for over an hour between the two of us so she had plenty of quotes to pick from. " There is no such thing as bad publicity except your own obituary.

Yes, we'd be glad to talk about 's practice on an IMP call.

,Let us know when the article comes out.

Would you and your partner doing the community supported practice being willing to share the story on an IMP call?

SharonSharon McCoy MDRenaissance Family Medicine

10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax:

www.SharonMD.com

She initially asked a lot of questions about whether or how often we needed to take out loans to meet payroll. Did we use SBA loans? How many staff did we employ per physician? etc. She was very interested in how many physicians in our county had quit or gone employed (all primary care docs here except us and one solo internist). She also was interested in my partner's 1/2 cash practice.

After I spoke with her she spent 45 min. on the phone with my business manager. We both stressed the fact that we're doing very well at the moment but that primary care is fragile and SGR and the payments not keeping up with costs are forcing us to consider dropping Medicare and other third party payers entirely. We also stress our view that independent >> employed.

Who knows how she'll use our quotes. That's the risk with talking to reporters but I did like her first article.Her next article should come out in a few days.

What did you tell her?

WK

From: Pierce

Sent: Thursday, January 05, 2012 3:00 PM

To:

Subject: Re: Doctors going out of business

Our business manager and I were interviewed by this same reporter this morning. We'll see how her next article turns out.

On cnn page today. I cant even imagine having expenses of 1.5 mil per month. I had no idea that is how oncology works.

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3

g

=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)http://www.pctools.com

=======

January 11, 2012

It depends on how many people in your area that can pay for care outside of insurance. Any given area can only support 1 cash practice. I am sure MVP has good numbers on this. There are many doctors that have tried working outside the system and there isn’t the client base to support them and they end up back in. I am glad you got out early enough to grab that niche in your area. My patients barely afford co-pays much less full price. Just because it is working for you doesn’t mean it can work for every doctor. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Dr LevinSent: Tuesday, January 10, 2012 8:01 PMTo: Subject: Re: Re: Doctors going out of business Depends on area established, payor coverage, and numbers of primary care available in your area... Re: Doctors going out of business What good is a micro practice if you still have to deal with all the burdens of third party insurance contracts?Private offices that remain in the third party system will soon be gone if the present Obamacare scheme continues. But those that innovate away from the system will and should thrive.Steve Horvitzstown, NJ> > >>>> > >>>> **> > >>>>> > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > >>>> per month. I had no idea that is how oncology works.> > >>>>> > >>>>> > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > >>>>> > >>>> g> > >>>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>>> > >>> =======> > >>> Email scanned by PC Tools - No viruses or spyware found.> > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > >>> =======> > >>>> > >>>> > >>>> > >>>> > >>>> > >>> =======> > >>> Email scanned by PC Tools - No viruses or spyware found.> > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > >>> =======> > >>>> > >>>> > >>> > > > > >> >>

January 11, 2012

Have you considered doing house calls? If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you? Or close early one day/week? Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients. Steve does a few for non-ambulatory pts. We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation. He does them at lunch or at the end of the day - about 1-2 visits per month. They do pay better than an office visit. Just a though....

Pratt

same here as Deb and KAthy and Sharlene I look back at a full schedule of yr ago to see 2 who have died(Maine is the oldest state in the union and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here one or two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and can offer sliding fees to see people for 5.00 whicih I cannot do, and they take the mainecare folks thogh I see plenty of those I cannot see enough to be paid well.

Last yr I had the best financial yr I ever had I brought home 14,800 more than 2010 But I struggle to keep the schedule full weird but true The model works but I do hrs and hrs of work for folks have no money and no transportation When they cannot get in I cannot get paid Yesterday a woman discharged form a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and is not getting the antibx and is out there calling me stuck in the woods with now a non flushed picc line. augh!

The guy upstairs is a family doc- who works a day a week in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns Everyone has something to try to survive really it is a mess for docs and bad for patietns out here

If we cannot join up together as professionals and do what is good for patietns and good for primary care soon boy we is doomed.

My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office. They drive unregistered vehicles or get rides

When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance. When they need specialists it is difficult to find them for these pts.

It really is sad...

" But those that innovate away from the system will and should thrive. " Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for them, because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to " protect " them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >>>> > > >>>> **> > > >>>>> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >>>> per month. I had no idea that is how oncology works.

> > > >>>>> > > >>>>> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > > >>>>> > > >>>> g> > > >>>>> > > >>>> > > >>>> > > >>>> > > >>>

> > > >>>> > > >>>> > > >>>> > > >>> =======> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >>> =======> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>> =======

> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >>> =======> > > >>>> > > >>>> > > >>> > > > > > > >> > >> >>

-- MD ph fax

January 11, 2012

I do house calls occasionally Most of them have no insurance that will pay for it and if they do they get home nurses.and if they do not they aren't going to pay me The pICC line patietn has no insurance and hence cannot get Home health.

Thats the short version Nothing is simple.

Have you considered doing house calls? If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you? Or close early one day/week? Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients. Steve does a few for non-ambulatory pts. We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation. He does them at lunch or at the end of the day - about 1-2 visits per month. They do pay better than an office visit. Just a though....

Pratt

same here as Deb and KAthy and Sharlene I look back at a full schedule of yr ago to see 2 who have died(Maine is the oldest state in the union and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here one or two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and can offer sliding fees to see people for 5.00 whicih I cannot do, and they take the mainecare folks thogh I see plenty of those I cannot see enough to be paid well.

Last yr I had the best financial yr I ever had I brought home 14,800 more than 2010 But I struggle to keep the schedule full weird but true The model works but I do hrs and hrs of work for folks have no money and no transportation When they cannot get in I cannot get paid Yesterday a woman discharged form a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and is not getting the antibx and is out there calling me stuck in the woods with now a non flushed picc line. augh!

The guy upstairs is a family doc- who works a day a week in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns Everyone has something to try to survive really it is a mess for docs and bad for patietns out here

If we cannot join up together as professionals and do what is good for patietns and good for primary care soon boy we is doomed.

My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office. They drive unregistered vehicles or get rides

When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance. When they need specialists it is difficult to find them for these pts.

It really is sad...

" But those that innovate away from the system will and should thrive. " Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for them, because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to " protect " them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >>>> > > >>>> **> > > >>>>> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >>>> per month. I had no idea that is how oncology works.

> > > >>>>> > > >>>>> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > > >>>>> > > >>>> g> > > >>>>> > > >>>> > > >>>> > > >>>> > > >>>

> > > >>>> > > >>>> > > >>>> > > >>> =======> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >>> =======> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>> =======

> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >>> =======> > > >>>> > > >>>> > > >>> > > > > > > >> > >> >>

-- MD ph fax

January 11, 2012

Well said!

Wen

Remember, we Americans, think that we have a health care services similar to France's, but we want the services offered to the Swedes, when in reality we have a system similar to the Russians. At least in my neck of the woods the only thing worse that paying a Doctor for services is paying for parking tickets.

The system would never change as long as the consumer, patients, like the status quo and we, providers, provide free care. Personally, I won't move a finger if I am not reimbursed. Patient wants work physical and insurance won't cover it, I have the letter of denial, pay cash for it or it won't get done. Patient needs full disability evaluation, I give the the number of the disability doctor that charge a hefty fee for the trouble. Aetna wants to pay 5 dollars for capitation, gone. Insurance wants to bundle EKG or PFT into visit, I would refer you to the specialist to get them done. Insurance won't cover vaccinations, I would hand patient address and number for Department of Health to get it done. I also inform patient's that hey would need to go thru the trouble because their insurance won't pay me for the service. I also give them the info that Humana's CEO makes 20 million a year but Humana won't pay for services. I would do very limited prior authorization's, for the few patient's that really need it. Patient does not want to take generics, I am sorry. You can't pay and I give you the address for the City clinic and for the Hospital.

Some patient's go elsewhere, it is true, but it make me feel better that I am not working for free or doing administrative stuff that I should not be doing. And the practice runs better that way.I strongly believe that as long as we take the slack for patient's lack of desire to pay us directly or making their insurance company pay us for services is what perpetuates the inhumane disaster we are currently in.

Patient's are very savvy, I already had 4 show up to stick me with their deductible a go back to their prior provider. Multiple times I have them show up weeks prior to their coverage ends, just because their provider won't give them an appointment prior to their termination date. If a patient can't pay the 5 dollar copayment at the time of service I won't see them because their would be a 50 / 50 chance for them not coming back if the owe 5 dollars, if I don't see them chances are 95% they would come back.

If we all stop working for free, like lawyers, mechanics, supermarkets, the phone company and others, no matter what happens, the system would be fixed in less than a year.My 2 cents, from The Barrio

And I'm guessing no insurance = no income? We see quite a few patients with no insurance, but they can still usually afford something to pay us. They also tend to be the most grateful and compliant patients! But we have a much different demographic here than you do....

I hate two things about medicine: 1. That patients all think they shouldn't have to pay anything for it. And 2. That the system has put insurance, Medicare, and Medicaid between the patient and the physician (meaning that patients don't think they can afford to see a doctor until it's really too late - when they don't have insurance). But I think I'm preaching to the choir here.

Pratt

I do house calls occasionally Most of them have no insurance that will pay for it and if they do they get home nurses.and if they do not they aren't going to pay me The pICC line patietn has no insurance and hence cannot get Home health.

Thats the short version Nothing is simple.

Have you considered doing house calls? If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you? Or close early one day/week? Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients. Steve does a few for non-ambulatory pts. We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation. He does them at lunch or at the end of the day - about 1-2 visits per month. They do pay better than an office visit. Just a though....

Pratt

same here as Deb and KAthy and Sharlene I look back at a full schedule of yr ago to see 2 who have died(Maine is the oldest state in the union and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here one or two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and can offer sliding fees to see people for 5.00 whicih I cannot do, and they take the mainecare folks thogh I see plenty of those I cannot see enough to be paid well.

Last yr I had the best financial yr I ever had I brought home 14,800 more than 2010 But I struggle to keep the schedule full weird but true The model works but I do hrs and hrs of work for folks have no money and no transportation When they cannot get in I cannot get paid Yesterday a woman discharged form a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and is not getting the antibx and is out there calling me stuck in the woods with now a non flushed picc line. augh!

The guy upstairs is a family doc- who works a day a week in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns Everyone has something to try to survive really it is a mess for docs and bad for patietns out here

If we cannot join up together as professionals and do what is good for patietns and good for primary care soon boy we is doomed.

My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office. They drive unregistered vehicles or get rides

When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance. When they need specialists it is difficult to find them for these pts.

It really is sad...

" But those that innovate away from the system will and should thrive. " Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for them, because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to " protect " them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >>>> > > >>>> **> > > >>>>> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >>>> per month. I had no idea that is how oncology works.

> > > >>>>> > > >>>>> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > > >>>>> > > >>>> g> > > >>>>> > > >>>> > > >>>> > > >>>> > > >>>

> > > >>>> > > >>>> > > >>>> > > >>> =======> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >>> =======> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>> =======

> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > >>> =======> > > >>>> > > >>>> > > >>> > > > > > > >> > >> >>

-- MD

ph fax

-- MD ph fax

January 12, 2012

House calls for 1 hour visit pays between 79 and 119. I just had Medicare pre-audit my notes and down code every house call - 7 so are and 5 not yet received back. I have 10 home care patients. Do only if you have to.

I am appealing.

To: " " < > Sent: Wednesday, January 11, 2012 9:34 AMSubject: Re: Re: Doctors going out of business

Have you considered doing house calls? If your schedule is not full, could you take 1-2 days per month to go to your patients that can't get to you? Or close early one day/week? Obviously doesn't help the pt with the Picc line (no home health nurses?), but could help your other patients. Steve does a few for non-ambulatory pts. We do not advertise it, and the pt has to be established and Steve offers if he sees it is a difficult situation. He does them at lunch or at the end of the day - about 1-2 visits per month. They do pay better than an office visit. Just a though....

Pratt

same here as Deb and KAthy and Sharlene I look back at a full schedule of yr ago to see 2 who have died(Maine is the oldest state in the union and the oldest people live in my town I swear) 1or 2 have moved to find work- the economy was so bad here before the recession we never saw much differnce there is nothing here one or two may have moved on for another reason There is an abundance of PCPs here the hospitla keeps getting more and can offer sliding fees to see people for 5.00 whicih I cannot do, and they take the mainecare folks thogh I see plenty of those I cannot see enough to be paid well.Last yr I had the best financial yr I ever had I brought home 14,800 more than 2010 But I struggle to keep the schedule full weird but true The model works but I do hrs and hrs of work for folks have no money and no transportation

When they cannot get in I cannot get paid Yesterday a woman discharged form a hospital 1 hr away with a PICC line needing 6 days of antibx that this hospital says I have to write the orders for becasue I am the one with local prvileges and she cannot come in to see me and is not getting the antibx and is out there calling me stuck in the woods with now a non flushed picc line. augh!The guy upstairs is a family doc- who works a day a week in industrial setting and mostly does derm now. Others have tiny offices and spouses with good jobs and churn patietns Everyone has something to try to survive really it is a mess for docs and bad for patietns out hereIf we cannot join up together as professionals and do what is good for patietns and good for primary care soon boy we is doomed.

My patients are over 50% medicaid. Some don't even have vehicles to make it to my suburban office. They drive unregistered vehicles or get rides

When I started ; I live in the next town; I didn't realize the poverty in our area. Some have so many issues as they haven't been able to get a PCP ho took their insurance. When they need specialists it is difficult to find them for these pts.

It really is sad...

"But those that innovate away from the system will and should thrive." Steve, I really don't think that is true in all locations. I live in a relatively poor, rural area, and I know without a doubt that I would lose most of my patients if I did not accept their insurance. They love the care and service that I give, but the bottom line is their budgets, and most of those are stretched to the limits. And I really can't blame them for wanting to use the insurance that they are paying so much for. This past summer, I really searched my soul to see if I even dared to charge a $200 noncovered benefits fee, but I decided that most of them would leave even over that. Also, although there are quite a few uninsured people around, they tend not to come in until they are wrecks, and they are so poor that I feel obligated to undercharge them for the amount of time and energy I spend trying to help them. I also feel some extra malpractice risk when I care for

them, because they usually won't even go for any labs or tests. (There are no discounted labs anywhere around, and NY State sees fit to "protect" them from those cool, discounted deals you see on the internet.) Now, I know I could pull up stakes and start all over in some more affluent area, but this is where all my family is, and the thought of starting over after the past 3+ years of hard work is pretty much unbearable, besides the fact there is no money left. I do dream about it sometimes, though!---Sharlene

> > > >>>> > > >>>> **> > > >>>>> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >>>> per month. I had no idea that is how oncology works.> > > >>>>> > > >>>>> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > > >>>>> > > >>>> g> > > >>>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>> =======> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database:

6.19000)> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >>> =======> > > >>>> > > >>>> > > >>>> > > >>>> > > >>>> > > >>> =======> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >>> =======> > > >>>> > > >>>> > > >>> > > > > > > >> > >> >>

-- MD ph fax

January 12, 2012

My house call notes are just as detailed as my regular notes, so I hope they

would withstand an audit, which I haven't experienced yet. I agree with Myria

(probably b/c I'm also in upstate NY), that they don't pay enough better than an

office visit to cover the time you spend out of the office. Since driving time

is not included in the reimbursement for a housecall, I would think we could

rightly charge the patient extra for that, if we thought they had money to pay!

Sharlene

> > > > >>>

> > > > >>>> **

> > > > >>>>

> > > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil

> > > > >>>> per month. I had no idea that is how oncology works.

> > > > >>>>

> <http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=h

> p_t3>

> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp

> _t3<

> <http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=

> hp_t3>

> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=h

> p_t3>

> > > > >>>>

> > > > >>>> g

> > > > >>>>

> > > > >>>

> > > > >>> =======

> > > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > > >>> <http://www.pctools.com/> http://www.pctools.com

> <http://www.pctools.com/> <

> <http://www.pctools.com/?cclick=EmailFooterClean_51>

> http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > > >>> =======

> > > > >>>

> > > > >>> =======

> > > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > > >>> <http://www.pctools.com/> http://www.pctools.com

> <http://www.pctools.com/> <

> <http://www.pctools.com/?cclick=EmailFooterClean_51>

> http://www.pctools.com/?cclick=EmailFooterClean_51>

> > > > >>> =======

> > > > >>>

> > > > >>

> > > > >

> > > >

> > >

> >

>

> --

>

> MD

>

> ph fax

> <http:///>

>

January 12, 2012

Just to make every one feel better: http://money.cnn.com/galleries/2012/smallbusiness/1201/gallery.doctors-broke/index.html

WK

From: sharkinn

Sent: Wednesday, January 11, 2012 9:53 PM

To:

Subject: Re: Doctors going out of business

My house call notes are just as detailed as my regular notes, so I hope they would withstand an audit, which I haven't experienced yet. I agree with Myria (probably b/c I'm also in upstate NY), that they don't pay enough better than an office visit to cover the time you spend out of the office. Since driving time is not included in the reimbursement for a housecall, I would think we could rightly charge the patient extra for that, if we thought they had money to pay! Sharlene> > > > >>>> > > > >>>> **> > > > >>>>> > > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > > >>>> per month. I had no idea that is how oncology works.> > > > >>>>> > > > >>>>> > > > >>>>> <http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=h> p_t3>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp> _t3<> <http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=> hp_t3>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=h> p_t3>> > > > >>>>> > > > >>>> g> > > > >>>>> > > > >>>> > > > >>>> > > > >>>> > > > >>>> > > > >>>> > > > >>>> > > > >>>> > > > >>> =======> > > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > > >>> <http://www.pctools.com/> http://www.pctools.com> <http://www.pctools.com/> <> <http://www.pctools.com/?cclick=EmailFooterClean_51>> http://www.pctools.com/?cclick=EmailFooterClean_51>> > > > >>> =======> > > > >>>> > > > >>>> > > > >>>> > > > >>>> > > > >>>> > > > >>> =======> > > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > > >>> <http://www.pctools.com/> http://www.pctools.com> <http://www.pctools.com/> <> <http://www.pctools.com/?cclick=EmailFooterClean_51>> http://www.pctools.com/?cclick=EmailFooterClean_51>> > > > >>> =======> > > > >>>> > > > >>>> > > > >>> > > > > > > > > >> > > >> > >> >> > > > > > > -- > > > > MD> > > ph fax > <http:///> > <http:///>>=======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19030)http://www.pctools.com======= =======Email scanned by PC Tools - No viruses or spyware found.(Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19030)http://www.pctools.com=======

January 16, 2012

Myria, did you know that our Medicare carrier requires that you put the actual

CLOCK TIMES you spend with the patient for the counseling codes, such as 2:00 to

3:00 PM, rather than just the number of minutes (such as 60). And don't forget

to use their precious words, " face-to-face. " If either is missing, you will lose

an audit or appeal, as I found out the hard way. I just billed a level 5 home

visit by time (GI bleed, decision not to hospitalize, new home DNR order, etc,)

I'll be prepared for the appeal and let you know if it flies! ---Sharlene

> >> > > >>>

> >> > > >>>> **

> >> > > >>>>

> >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil

> >> > > >>>> per month. I had no idea that is how oncology works.

> >> > > >>>>

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<\

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3\

>

> >> > > >>>>

> >> > > >>>> g

> >> > > >>>>

> >> > > >>>

> >> > > >>> =======

> >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> >> > > >>> =======

> >> > > >>>

> >> > > >>> =======

> >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> >> > > >>> =======

> >> > > >>>

> >> > > >>

> >> > > >

> >> > >

> >> >

> >>

> >Â

> >

> >--

> >

> >Â Â Â MD

> >Â Â Â

> >ph Â Â fax

> >

> Â

>

January 16, 2012

is it truly worth your time to appeal?

Steve Horvitz

> > >> > > >>>

> > >> > > >>>> **

> > >> > > >>>>

> > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5

mil

> > >> > > >>>> per month. I had no idea that is how oncology works.

> > >> > > >>>>

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<\

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3\

>

> > >> > > >>>>

> > >> > > >>>> g

> > >> > > >>>>

> > >> > > >>>

> > >> > > >>> =======

> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > >> > > >>> =======

> > >> > > >>>

> > >> > > >>> =======

> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > >> > > >>> =======

> > >> > > >>>

> > >> > > >>

> > >> > > >

> > >> > >

> > >> >

> > >>

> > >Â

> > >

> > >--

> > >

> > >Â Â Â MD

> > >Â Â Â

> > >ph Â Â fax

> > >

> > Â

> >

>

January 16, 2012

Sharlene thanks, I have not been informed that they now required clock time (what are we babies who can't tell time or thiefs like the system is?)

Yes, it's worth the time to appeal. I win about 2/3 of the time.

To: Sent: Monday, January 16, 2012 11:37 AMSubject: Re: Doctors going out of business

is it truly worth your time to appeal?Steve Horvitz> > >> > > >>>> > >> > > >>>> **> > >> > > >>>>> > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > >> > > >>>> per month. I had no idea that is how oncology works.> > >> > > >>>>> > >> > > >>>>> > >> > >

>>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > >> > > >>>>> > >> > > >>>> g> > >> > > >>>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>> =======> > >>

> > >>> Email scanned by PC Tools - No viruses or spyware found.> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>> =======> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > >> > > >>> (Email Guard: 7.0.0.27,

Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>> > >> > > > > > >> > > >> > >> > >> > >> >> > >>> > >Ã‚ > > >> > >> > >> > >-- > > >> > >> > >> > >Ã‚ Ã‚ Ã‚ MD> > >Ã‚ Ã‚ Ã‚ > > >Ã‚

Ã‚ Ã‚ > > >ph Ã‚ Ã‚ fax > > >> > Ã‚ > >>

January 16, 2012

The EMRs can do this #$%$# work for you IF you do the note when you start the visit and finish it at the end of the vi sit Not possible for alot of us There is a timer thing to turn on on mine that can document. IF you can do your notes that waythe machine can do this automatically for you.Aw you probably knew that

Sharlene thanks, I have not been informed that they now required clock time (what are we babies who can't tell time or thiefs like the system is?)

Yes, it's worth the time to appeal. I win about 2/3 of the time.

To: Sent: Monday, January 16, 2012 11:37 AM

Subject: Re: Doctors going out of business

is it truly worth your time to appeal?Steve Horvitz

> > >> > > >>>> > >> > > >>>> **> > >> > > >>>>> > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil

> > >> > > >>>> per month. I had no idea that is how oncology works.> > >> > > >>>>> > >> > > >>>>> > >> > >

>>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>

> > >> > > >>>>> > >> > > >>>> g> > >> > > >>>>> > >> > > >>>> > >> > > >>>

> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>

> > >> > > >>> =======> > >>

> > >>> Email scanned by PC Tools - No viruses or spyware found.> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>>> > >> > > >>>

> > >> > > >>>> > >> > > >>> =======> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > >> > > >>> (Email Guard: 7.0.0.27,

Virus/Spyware Database: 6.19000)> > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

> > >> > > >>> =======> > >> > > >>>> > >> > > >>>> > >> > > >>> > >> > > >

> > >> > > >> > >> > >> > >> >> > >>> > >Â > > >> > >> > >> > >-- > > >

> > >> > >> > >Â Â Â MD> > >Â Â Â > > >Â

Â Â > > >ph Â Â fax > > >

> > Â > >>

-- MD ph fax

January 19, 2012

Simple. If the price was agreed on beforehand and he still refuses, fire the patient. If the price wasn't agreed on, then there's a misunderstanding that needs to be cleared up; either you agree with the patient's assessment that you're willing to accept only $150 (and possibly accept only what he feels like paying you in the future for future services), or you disagree and demand satisfaction of the debt, else you will terminate the relationship. These are the exact same alternatives that doctors have available with insurance companies that pull this kind of B.S.KenSent from my iPad

OK

How bout this scenario.

A patient you have known for quite a few years comes in for a visit. The visit takes about 45 minutes due to the complexity. The patient has switched jobs, and is presently self insured, although he has plenty of available funds in his bank account.

Your fee is $200.

You go on to the next patient. 5 minutes later your front desk person, if you have one, knocks on your door and states the patient does not want to pay your $200 bill. He will only pay $150. Remember this is not because he does not have the funds. He has plenty of money. He is just choosing to downcode your fee to save money.

What do you do?

Horvitz, D.O.

stown, Nj

> > > > >> >

> > > > >> > I like both articles. I may post them on my office bulletin board at some time. They certainly mirror my own grim thoughts. I thought I was doing quite well last year at this time, at the end of my second year of solo, ultra-low-overhead micropractice. But income is down, self-employment taxes are higher than I anticipated, personal savings used to finance this venture

January 19, 2012

mmm Here I Â see the patient only after the payment is collected. For years I fought the need to be so hard, but have been burnt often enough, that it comes easily now, if I am not paid I cannot set the time aside for you.

Sangeetha

Â

Simple. Â If the price was agreed on beforehand and he still refuses, fire the patient. Â If the price wasn't agreed on, then there's a misunderstanding that needs to be cleared up; either you agree with the patient's assessment that you're willing to accept only $150 (and possibly accept only what he feels like paying you in the future for future services), or you disagree and demand satisfaction of the debt, else you will terminate the relationship. Â These are the exact same alternatives that doctors have available with insurance companies that pull this kind of B.S.

KenSent from my iPad

Â

OK

How bout this scenario.

A patient you have known for quite a few years comes in for a visit. The visit takes about 45 minutes due to the complexity. The patient has switched jobs, and is presently self insured, although he has plenty of available funds in his bank account.

Your fee is $200.

You go on to the next patient. 5 minutes later your front desk person, if you have one, knocks on your door and states the patient does not want to pay your $200 bill. He will only pay $150. Remember this is not because he does not have the funds. He has plenty of money. He is just choosing to downcode your fee to save money.

What do you do?

Horvitz, D.O.

stown, Nj

> > > > >> >

> > > > >> > I like both articles. I may post them on my office bulletin board at some time. They certainly mirror my own grim thoughts. I thought I was doing quite well last year at this time, at the end of my second year of solo, ultra-low-overhead micropractice. But income is down, self-employment taxes are higher than I anticipated, personal savings used to finance this venture

January 19, 2012

Billing is not based on number of diagnoses. It is based on elements of care,

unless you bill on time. I bill about 70% 214's and have never had one

downcoded. If you bill on time and document it they should pay. For a 214, it is

25 minutes. If you send a copy of your bill, perhaps there were two few elements

to reach a 214 code, and if you did not bill on time that could be the reason.

________________________________________

From:

[ ] On Behalf Of Egly

[kevin_egly@...]

Sent: Wednesday, January 18, 2012 6:42 AM

To:

Subject: Re: Re: Doctors going out of business

did a 99214 for total time 30 minutes but was downgraded brcause only two

diagnositic codes. We wrote two explainations and could never get anyone on the

phone, just the writen denialk that claim did not meet medical necessity.

Left us scratching our heads.

Too much time for 10-20 dollars!!!

Subject: Re: Doctors going out of business

To:

Date: Tuesday, January 17, 2012, 10:06 AM

Myria:

I do not wish to be a nuisance, just interested in the numbers.

Have you calculated out how much time you spent overall preparing for and doing

the appeals, and how much money you recieved for your efforts?

Is the $$/hour worth it?

Steve

moorestown, NJ

> > > >> > > >>>

> > > >> > > >>>> **

> > > >> > > >>>>

> > > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5

mil

> > > >> > > >>>> per month. I had no idea that is how oncology works.

> > > >> > > >>>>

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<\

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3\

>

> > > >> > > >>>>

> > > >> > > >>>> g

> > > >> > > >>>>

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>>

http://www.pctools.com<http://www.pctools.com/><http://www.pctools.com/?cclick=E\

mailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>> =======

> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

> > > >> > > >>>

http://www.pctools.com<http://www.pctools.com/><http://www.pctools.com/?cclick=E\

mailFooterClean_51>

> > > >> > > >>> =======

> > > >> > > >>>

> > > >> > > >>

> > > >> > > >

> > > >> > >

> > > >> >

> > > >>

> > > >Ã‚Â

> > > >

> > > >--

> > > >

> > > >Ã‚Â Ã‚Â Ã‚Â MD

> > > >Ã‚Â Ã‚Â Ã‚Â

> > > >ph Ã‚Â Ã‚Â fax

> > > >

> > > Ã‚Â

> > >

> >

>

January 19, 2012

Sangeetha

Yet you set aside time for patients with insurers who downcode you every day of

the week. Why treat self pay patients any different than patients with third

party payers?

Horvitz

stown, NJ

> > > > > > >> >

> > > > > > >> > I like both articles. I may post them on my office bulletin

> > board at some time. They certainly mirror my own grim thoughts. I thought I

> > was doing quite well last year at this time, at the end of my second year

> > of solo, ultra-low-overhead micropractice. But income is down,

> > self-employment taxes are higher than I anticipated, personal savings used

> > to finance this venture

> >

>

January 19, 2012

Because there are contracts in place.

And yes I do not accept some of the overseas insurances and their promises, because I do not have contracts with them.

I have found my ability to collect from patients after they have been seen is worse than my ability to collect from insurances. Way worse...

Sangeetha Murthy

Â

Sangeetha

Yet you set aside time for patients with insurers who downcode you every day of the week. Why treat self pay patients any different than patients with third party payers?

Horvitz

stown, NJ

> > > > > > >> >

> > > > > > >> > I like both articles. I may post them on my office bulletin

> > board at some time. They certainly mirror my own grim thoughts. I thought I

> > was doing quite well last year at this time, at the end of my second year

> > of solo, ultra-low-overhead micropractice. But income is down,

> > self-employment taxes are higher than I anticipated, personal savings used

> > to finance this venture

> >

>

January 21, 2012

I've had this happen when I've forgotten to write "30 minutes with patient > 1/2 in counseling". Now some insurances are asking for the start and stop time to be documented as well.

I may have "clean the attic" as my only to do but it's certainly going to take me quite a bit of time to do it, right?

To: Sent: Wednesday, January 18, 2012 8:42 AMSubject: Re: Re: Doctors going out of business

did a 99214 for total time 30 minutes but was downgraded brcause only two diagnositic codes. We wrote two explainations and could never get anyone on the phone, just the writen denialk that claim did not meet medical necessity.

Left us scratching our heads.

Too much time for 10-20 dollars!!!

Subject: Re: Doctors going out of businessTo: Date: Tuesday, January 17, 2012, 10:06 AM

Myria:I do not wish to be a nuisance, just interested in the numbers.Have you calculated out how much time you spent overall preparing for and doing the appeals, and how much money you recieved for your efforts?Is the $$/hour worth it?Stevemoorestown, NJ> > > >> > > >>>> > > >> > > >>>> **> > > >> > > >>>>> > > >> > > >>>> On cnn page today. I cant even imagine having expenses of 1.5 mil> > > >> > > >>>> per month. I had no idea that is how oncology works.> > > >> > > >>>>> > > >> > > >>>>> > > >> > > >>>> http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3>> > > >> > > >>>>> > > >> > > >>>> g> > > >> > > >>>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > >

>>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> =======> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >> > > >>> =======> > > >> > > >>>> >

> >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> =======> > > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.> > > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)> > > >> > > >>> http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>> > > >> > > >>>

=======> > > >> > > >>>> > > >> > > >>>> > > >> > > >>> > > >> > > > > > > >> > > >> > > >> > >> > > >> >> > > >>> > > >Ãƒâ€šÃ‚ > > > >> > > >> > > >> > > >-- > > > >> > > >> > > >> > > >Ãƒâ€šÃ‚ Ãƒâ€šÃ‚ Ãƒâ€šÃ‚ MD> > > >Ãƒâ€šÃ‚ Ãƒâ€šÃ‚ Ãƒâ€šÃ‚ > > > >Ãƒâ€šÃ‚ Ãƒâ€šÃ‚ Ãƒâ€šÃ‚ > > > >ph Ãƒâ€šÃ‚ Ãƒâ€šÃ‚ fax > > > >> > >

Ãƒâ€šÃ‚ > > >> >>

January 24, 2012

Steve,

I think that is what all the insurance companys want us to think..

it is worth the time to appeall!!!.

It is costly and time consuming yes...but the denial I think is just

them finding any way not pay...

Deb

> is it truly worth your time to appeal?

>

> Steve Horvitz

>

>> > >> > > >>>

>> > >> > > >>>> **

>> > >> > > >>>>

>> > >> > > >>>> On cnn page today. I cant even imagine having expenses of

>> > >> > > >>>> 1.5 mil

>> > >> > > >>>> per month. I had no idea that is how oncology works.

>> > >> > > >>>>

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<\

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3\

>

>> > >> > > >>>>

>> > >> > > >>>> g

>> > >> > > >>>>

>> > >> > > >>>

>> > >> > > >>> =======

>> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

>> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

>> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

>> > >> > > >>> =======

>> > >> > > >>>

>> > >> > > >>> =======

>> > >> > > >>> Email scanned by PC Tools - No viruses or spyware found.

>> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database: 6.19000)

>> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

>> > >> > > >>> =======

>> > >> > > >>>

>> > >> > > >>

>> > >> > > >

>> > >> > >

>> > >> >

>> > >>

>> > >Â

>> > >

>> > >--

>> > >

>> > >Â Â Â MD

>> > >Â Â Â

>> > >ph Â Â fax

>> > >

>> > Â

>> >

>>

>

February 15, 2012

Low overhead..

> 80-90% of your practice is with one insurer, and it is United!!

>

> I am sorry, but you are screwed!

>

> How do you stay in business?

>

> Horvitz

> stown, NJ

>

>> >> >> >> > >> > > >>>

>> >> >> >> > >> > > >>>> **

>> >> >> >> > >> > > >>>>

>> >> >> >> > >> > > >>>> On cnn page today. I cant even imagine having

>> >> >> >> > >> > > >>>> expenses

>> >> >> >> > >> > > >>>> of

>> >> >> >> > >> > > >>>> 1.5 mil

>> >> >> >> > >> > > >>>> per month. I had no idea that is how oncology

>> >> >> >> > >> > > >>>> works.

>> >> >> >> > >> > > >>>>

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3<\

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index..htm?hpt=hp_t3\

>

>> >> >> >> > >> > > >>>>

>> >> >> >> > >> > > >>>> g

>> >> >> >> > >> > > >>>>

>> >> >> >> > >> > > >>>

>> >> >> >> > >> > > >>> =======

>> >> >> >> > >> > > >>> Email scanned by PC Tools - No viruses or spyware

>> >> >> >> > >> > > >>> found.

>> >> >> >> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database:

>> >> >> >> > >> > > >>> 6.19000)

>> >> >> >> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

>> >> >> >> > >> > > >>> =======

>> >> >> >> > >> > > >>>

>> >> >> >> > >> > > >>> =======

>> >> >> >> > >> > > >>> Email scanned by PC Tools - No viruses or spyware

>> >> >> >> > >> > > >>> found.

>> >> >> >> > >> > > >>> (Email Guard: 7.0.0.27, Virus/Spyware Database:

>> >> >> >> > >> > > >>> 6.19000)

>> >> >> >> > >> > > >>>

http://www.pctools.com<http://www.pctools.com/?cclick=EmailFooterClean_51>

>> >> >> >> > >> > > >>> =======

>> >> >> >> > >> > > >>>

>> >> >> >> > >> > > >>

>> >> >> >> > >> > > >

>> >> >> >> > >> > >

>> >> >> >> > >> >

>> >> >> >> > >>

>> >> >> >> > >Â

>> >> >> >> > >

>> >> >> >> > >--

>> >> >> >> > >

>> >> >> >> > >Â Â Â MD

>> >> >> >> > >Â Â Â

>> >> >> >> > >ph Â Â fax

>> >> >> >> > >

>> >> >> >> > Â

>> >> >> >> >

>> >> >> >>

>> >> >> >

>> >> >>

>> >> >

>> >>

>> >

>>

>

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