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Re: Bad week everywhere? -- small practice blues

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RE are we immune to the world around us?1) Many of our pts are having trouble making ends meet -- why did we think we were immune to it?2) Yes, hard choices...I was concerned that many would not look at their case mixes to see if we could afford to care for many of the needy, not payors, Medicaid, etc, without a salary to the "big group" plan...will they keep us employed in the long run?3) In line with my promise to myself NOT to post depressing observations (yes me too, met with the group of docs at my local hospital who plan to sign away their rights of independence for a limited guarantee...) here's some ideas to keep me and you sane in this increasingly bizarre world of private practice medicine--- A) Make your chronic, stable pts come in at LEAST every 6 months. Yes, it would be great to get people in every 3 months but many won't as copays appear to be going up. Be sure they come in to see you when sick (still cheaper than ER). B) Some pts won't be happy with what you advise them to do. If you feel that others can convince them to do otherwise, call them on it, give them 30 days to find another doc....I do this in person. 1. Or, I have them sign off that they understand the risk of NOT being treated, and we move on. 2. NOONE has the right to make YOU feel bad. C) You cannot do EVERYTHING yourself. I chose to outsource billing at 8%/collected dollar. They do the billing and mailing, no extra fees. You CAN find these folks, big outfits, and they do a good job! Check with me and I'll send you the info (nope, don't get a referral fee......). Hang in there if you can, I've been there, worked HMO x 6 years, hospital owned x 8 years..................nope won't again, but that is my personal choice and options...............M in Western PATo: Sent: Thursday, August 9, 2012 10:44:25 PMSubject: RE: Bad week everywhere?

All these posts about doctors quitting are very disheartening. Kathy Saradarian, MDNJ From: [mailto: ] On Behalf Of Dannielle HarwoodSent: Thursday, August 09, 2012 9:28 PMTo: Subject: RE: Bad week everywhere? I hear each and everyone of you!!!!! and I have reached my breaking point. made decision to close my practice. My accountant and my husband staged an intervention with me! Pointed out that I am working a second job to keep my office open without a clear vision of what exactly could change to make it profitable.Have tried cutting expenses........... I do not even have 1 FTE on staff right now. Am doing my own billing.Am doing cash based weight loss as well as regular primary care.Have not been paid by Medicare since Nov 2011...I have hired that problem out to a professional? biller.Am getting letter from specialist in town that say it is my responsibility to let my patients known when their scheduled appointments is AND if my patient does not show up, cancels or reschedules more than once, I cannot refer there the patient again....so I guess I should now hire staff to make sure my patients show up their offices??? Yes because i am the one making so much $$$$.Blue Shield will contemplate paying me for a visit with a patient I dx'd with a vertebral fracture AFTER I submit and they review all of my notes, labs and rad studies related to this visit...seriously???? Let me pay someone to pull all that info together and fax it to you.All local radiology companies expect me to do a pre-auth for all the studies THEY will make money on.....yes let me pay someone to for that too!!!Exhausted and done!Dannielle Dannielle Harwood, MDPlease keep sharing....helps reduce stress.........alcohol is nice too...........not enough $ or time to go to camp in the west coast this year!!! :-( M in Western PATo: Sent: Thursday, August 9, 2012 10:34:20 AMSubject: Forgive my rant I just came to a realization that I wanted to share with you. In land the Medicaid office is full of people that are benignly incompetent (i.e. not necessarily hard working but occasionally try and are nice to talk to you) vs the Medicare contractor (Novitas Solutions) that suffers from a severe case of negligent incompetence (nasty and useless). I need to keep my rant short so I cannot go into the details of how I am in my third submission to become a medicare provider but I will be happy to share a bottle of wine and my fun stories during camp. By the way the State Medicaid office recognizes my voice and knows me by my first name. That should tell you something… Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone Fax http://www.care4yourhealth.org/ "Don't ever let injustice go by unchallenged." Help us make our community healthy -> http://www.care4yourhealth.org/wanttohelp.php <image003.jpg> -- MD ph fax http:/// -- MD ph fax

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