## BOHICA, doctors!

Ever had it before? Well you got it again.
Pyrrho
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### BOHICA, doctors!

Went in for my usual checkup. The nurse says, "Have a seat...WON'T BE LONG NOW..."

Anyway, the doctor was a bit pissed off. "I've been working 80 hours a week and I'm going bankrupt. The government stopped paying me!"

It seems the government wants so much paperwork, the doctor has to choose between actually doing patient care or doing paperwork. The government apparently wants data on the patients. "I'm being paid for performance now," he says. The government apparently thinks that by tracking certain patient data, they can tell if the doctor is or is not doing a good job. This is akin to what the insurance companies are doing. The doctor chose to do patient care, so the government stopped paying. "I'm old! I don't care! I don't want to work on a computer, I want to care for my patients!"

And, yes,

THANKS OBAMA

Oh, and 120/75, not the 145/100 my dentist said I had.
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Anaxagoras
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### Re: BOHICA, doctors!

Clearly the government should just pay doctors whatever they say they're owed, no questions asked.
A fool thinks himself to be wise, but a wise man knows himself to be a fool.
William Shakespeare

Doctor X
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### Re: BOHICA, doctors!

Save the doctors do not get to say what they are owed.

They get to apply to the government to persuade them that they earned what the government thinks they and the hospital are owned. Insurance companies follow suit. Since in an effort to Contain Cost, Medicare--who everyone follows--underpays extraordinarily, doctors and hospitals have to find ways to make up the slack with overcharges. Hence that $200 tylenol story. Then add in the uninsured that must be treated and for which you get . . . nothing. Sorry, Anax, need to hit you upside the head with the Cluestick 2000 on this one. --J.D. Mob of the Mean: Free beanie, cattle-prod and Charley Fan Club! "Doctor X is just treating you the way he treats everyone--as subhuman crap too dumb to breathe in after you breathe out."--Don DocX: FTW.--sparks "Doctor X wins again."--Pyrrho "Never sorry to make a racist Fucktard cry."--His Humble MagNIfIcence "It was the criticisms of Doc X, actually, that let me see more clearly how far the hypocrisy had gone."--clarsct "I'd leave it up to Doctor X who has been a benevolent tyrant so far."--Grammatron "Indeed you are a river to your people. Shit. That's going to end up in your sig."--Pyrrho "Try a twelve step program and accept Doctor X as your High Power."--asthmatic camel "just like Doc X said." --gnome WS CHAMPIONS X3!!! NBA CHAMPIONS!! Stanley Cup! SB CHAMPIONS X5!!!!! AL East Champs!! Anaxagoras Posts: 21433 Joined: Wed Mar 19, 2008 5:45 am Location: Yokohama/Tokyo, Japan Has thanked: 1382 times Been thanked: 1173 times ### Re: BOHICA, doctors! Doctor X wrote:Save the doctors do not get to say what they are owed. They get to apply to the government to persuade them that they earned what the government thinks they and the hospital are owned. Insurance companies follow suit. Since in an effort to Contain Cost, Medicare--who everyone follows--underpays extraordinarily, doctors and hospitals have to find ways to make up the slack with overcharges. Hence that$200 tylenol story.
Surely you agree that something must be done to contain the costs? Maybe they are going about it the wrong way. I agree that giving doctors extra paperwork to do is less than ideal. If you pay for each service provided, sometimes unnecessary services may be provided. Medicare underpays you say, but the total cost of it to taxpayers is enormous. What is the objective measure here? Compared to what other countries pay for the same procedures? Compared to what the wealthiest patients are able to pay?
Then add in the uninsured that must be treated and for which you get . . . nothing.
A problem which Obamacare attempts to fix by requiring everyone to have insurance and providing a subsidy for those who can't afford it.
Sorry, Anax, need to hit you upside the head with the Cluestick 2000 on this one.

--J.D.
I will admit that the website has been a fail of epic proportions. And it's a political disaster for Democrats. It obviously doesn't affect me personally, but Obama deserves to be blamed for screwing that up.

If there's a better idea out there to fix America's healthcare mess, I'm all for it. I'm all for constructive criticism. But simply offering blame without offering a better idea is not useful.
A fool thinks himself to be wise, but a wise man knows himself to be a fool.
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Cloverlief
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### Re: BOHICA, doctors!

I worked on this issue in my last two jobs, especially my last job. Yes, there is initially a lot of paperwork involved, but the doctor does not have to do it, unless they run a very small practice, and still, they can cut down on a lot of the paperwork involved if they invest in a good EMR (electronic medical record), which can allow them to automate much of the required information, and make it check boxes. In fact, because Medicaid and Medicare really want physician's offices to move to an EMR, they have developed one, and I believe initially were offering it free of charge (I want to say until the end of 2014, but I can't recall), and then after that a nominal fee. Also, if the physician adopts the uses of doing his reporting during the visit with the patient, he could save a lot of time and ultimately money.

What is a lot of initial paperwork, but will lead to higher reimbursements is if the physician's office works to become a Patient Centered Medical Home. I was working specifically on this requirement in my last job. As well as hammering out usable data that could be gathered by the physician that Medicaid will eventually make mandatory. But once that certification is met (and there are different levels), it is done, and doesn't need to be done again. Much of it has to do with having policies and procedures in place, using an EMR and having reasonable access to care available to a provider's patients.

I have been on both sides of the reporting issue, and quite honestly, some facilities really suck at reporting, but still expect ridiculously high reimbursements (cough, Concentra, cough), and some were exceptional at reporting, and often under billed their services. Hospitals are the worst. They over bill, bill for more services than they provided, bill atrociously and unethically high prices, and expect to be compensated at the highest rate possible.

I have seen it said time and time again that Medicaid's and Medicare's reimbursements are low, and yes, a doctor will probably only make about $35-60 dollars for an office visit, depending on where they are located, but considering most physicians are spending about 5 minutes with patients, then that isn't so bad. What we need are some reasonable guidelines on charges and oversight on what medical practitioners charge and why for everybody, not just for Medicare and Medicaid and some arbitrary bullshit some insurance company managed to wrangle out of providers. Chani Anaxagoras Posts: 21433 Joined: Wed Mar 19, 2008 5:45 am Location: Yokohama/Tokyo, Japan Has thanked: 1382 times Been thanked: 1173 times ### Re: BOHICA, doctors! Chani, thanks for the perspective of someone who actually works in the industry. I don't so probably my opinion is of little value here. From what Pyrrho said it appears that his doctor is old, doesn't want to use computers, and doesn't want to hire someone like you to use the computers or fill out the paperwork on his behalf. Maybe it's time for him to retire? It's none of my business I know, but maybe everybody's personal preferences can't always be accommodated? He's used to doing things a certain way, and he doesn't want to change. I understand that, but that's how the world works. Things change. If you can't adapt to the new ways, maybe it's time to hang it up? A fool thinks himself to be wise, but a wise man knows himself to be a fool. William Shakespeare Doctor X Posts: 67454 Joined: Fri Jun 04, 2004 8:09 pm Title: Collective Messiah Location: Your Mom Has thanked: 3371 times Been thanked: 2137 times ### Re: BOHICA, doctors! Anaxagoras wrote:Surely you agree that something must be done to contain the costs? Don't call me "Shirley." Consider this: "Surely you agree that something must be done to contain the cost of gasoline?" And you do that how? Price fixing? The problem is the material cost of treatment which "we" ["We?"--Ed.] want are far more than people realize. It does not matter if we agree that gas really should be$1 a proper gallon and not some faggy surrender-monkey litre or something. The cost is more. The other Big Ass Elephant in the Room Not Named Asthmatic is the malpractice insurance. If you have to clear $500,000 a year "off the top" to cover the mandatory insurance . . . good luck! Maybe they are going about it the wrong way. I agree that giving doctors extra paperwork to do is less than ideal. If you pay for each service provided, sometimes unnecessary services may be provided. Medicare underpays you say, but the total cost of it to taxpayers is enormous. What is the objective measure here? Compared to what other countries pay for the same procedures? Compared to what the wealthiest patients are able to pay? Congratulations! You have recognized The Problem. You are now free to move on to Solving the Middle East Crises. Which is why I do not hit you with the ClueStick2000 now . . . because no one knows the solution. Nous not only want affordable medical care WE WANT THE BESTEST AVAILABLES! Imagine if I demanded the "BESTEST" car for the price of . . . well . . . the shitbox I drive . . . actually, my Mighty Steed [Bicycle.--Ed.] was quite affordable at$500 some years ago. English engineering for once.

Where I disagree with the analogy I just vomited is we are an Ethical Society. We do not let people die because they cannot pay. We accord value to human life: I mean, how much is an illegal immigrant's baby worth? What's "it" going to become. They breed like rabbits anyways. BLAH BLAH

So stick that tot in the incubator, treat its hydrocephalus secondary to prematurity or its spina bifida--look up the life-long costs of caring for THAT! Mum should have chewed on some bark or something when breaking into 'Merica! Get that folate in her rather than that agave!

That rather is the problem: do we want to be rationing such things? If I have no job and cannot afford gasoline? Anyone giving me a free gallon of gas? Other than Asthmatic, but my car does not run on methane?

Then comes all the other shit: I loved--when I had the time--slapping Libertarians who loved the "pay for what you need" bullshit. Fine, your daughter has cancer. Here is a bill for 20 million dollars to develop the cancer drug that will cure her and 98% of Cute Tots with Lisps who get this cancer now. You also have to now wait 20 years for the drug to be researched and developed. Good luck! At least you can spend the college fund on hookers and blow. Though, to be honest, I think many Libertards would support Guv'mint subsidies for hookers and blow.

I digress.
A problem which Obamacare attempts to fix by requiring everyone to have insurance and providing a subsidy for those who can't afford it.
Which is why, on this point, I do not mind giving Obama, Labour, and now the Tories a "A for Effort." They recognize that such a situation is "Free Shit for Some which Must be Paid by Others." I do not drive the major highways much, but my taxes go to pay for it. I am not allowed to "pick 'n choose" on my 1044 "what" I want my tax dollars to pay for. As a Liberal Friend put it: "it's a civilization tax." Further, I do not think I want our physicians and the like to have to decide how to treat you based on \$--but it does happen. All of the fucking time.

"A for Effort" but all they had to do was go to a VA hospital and realize it does not work.
If there's a better idea out there to fix America's healthcare mess, I'm all for it. I'm all for constructive criticism. But simply offering blame without offering a better idea is not useful.
And if I had it I would not be here. I would be in my wall-to-wall mahogany office being [CENSORED--Ed.] by Mila Kunis under the direction of Selma Heyak and Katie Holmes thrown in "for Charity Reasons"--always need to right-off. So, no, I cannot retort with a "Hey, Stupid, When I am DONE with Your Mom [Tm.--Ed.] Screaming Out My Name to Your Wife Who is Taking Notes with Mila Kunis, I Will Tell You the Solution!"

So, here, borrow this ClueStick2000. . . .

--J.D.
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Shit. That's going to end up in your sig."--Pyrrho
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"just like Doc X said." --gnome

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Pyrrho
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### Re: BOHICA, doctors!

My doctor's situation, if I understood him correctly, is that he is expected to gather data above and beyond what he already has in the patient records. For example, he is required to estimate every patient's BMI, and he is required to report that and other statistics to the government. "The government", more likely some minor bureaucrat somewhere, then decides, on the basis of these data, whether or not the doctor is "performing," even if he cannot control the behavior of patients. Because, apparently, someone in the government decided that not enough of his patients were getting better according to whatever standard the government uses, they will not pay him for services rendered. Your patient died of terminal cancer? Fuck you, we're not paying you! Obese patient kept eating Krispy Kremes and got the sugar diabetes? Fuck you, we're not paying you! Despite those lurid and patently false examples, the basic premise remains: patients must improve according to government specifications or the doctor will not be paid for any services--all payments are suspended until such time as we deem suitable.

He believes that the government wants him to leave practice. He didn't, but he did sell his practice to an umbrella group and continues doing what he does under their auspices, which is working as a general practice physician caring for patients.

It's not unlike what's happening to teachers, who are required to file voluminous reports on student progress in addition to the mandatory tests. In Ohio, all this data goes to a private firm that applies an algorithm and issues a performance evaluation of the teacher, whose salary and career hang in the balance, even if they are teaching in the Cleveland urban schools where Johnny can't read because he can't be arsed to carry a fuckin' book, man, fuck this shit, school ain't for learning it for hangin' and smokin' up man, hey Boyce got some snow? Plus the grinding poverty and parents--usually just one parent, marriage being another thing of the past--who are in their own fucked up reality. Then there is the local government and the entrenched patronage system...

We are also given the opportunity to log on to WebMD and fill out a health assessment. Today it's voluntary, but HR has plainly said that eventually it will be mandatory.

A certain relative of mine was required, under her medical plan, to get a colonoscopy or be required to pay higher rates. She got the colonoscopy whether she needed one or not. Not that there is anything wrong with that...I should probably have one done myself, although I am so full of shit that it may take a year to clear the system.
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Abdul Alhazred
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### Re: BOHICA, doctors!

It's about total control.

Doctors conscripted as government spies.

We are in the hands of infinite evil.
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DrMatt
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### Re: BOHICA, doctors!

Abdul Alhazred wrote:It's about total control.

Doctors conscripted as government spies.

We are in the hands of infinite evil.
And some people think doctors aren't appointed by the government for checks and balances.
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### Re: BOHICA, doctors!

Pyrrho wrote:My doctor's situation, if I understood him correctly, is that he is expected to gather data above and beyond what he already has in the patient records. For example, he is required to estimate every patient's BMI,....

Actually this isn't that big of a deal if he is using an EMR, which will calculate that automatically. Most EMR's I have seen automatically calculate that. And quite honestly, when is the last time you went to the doctor's office and they didn't take your weight? Heck, I went in for a simple freaking TB test recently, and they took my weight and height. He has the information, and extrapolating it is pretty easy. In my last job, this is something we did, but although we had the BMI calculation % and graph of the BMI in the EMR, the practice made it so only the doctor's could see that. Why? I don't know. I pulled the BMI for every patient in the practice and put together a report every morning, and I had to calculate the BMI for about 40-60 patients daily. It took me about 20 to 30 minutes. It would have taken me about 10, if I didn't have to calculate the BMI myself.

Phyrrho wrote:... and he is required to report that and other statistics to the government. "The government", more likely some minor bureaucrat somewhere, then decides, on the basis of these data, whether or not the doctor is "performing," even if he cannot control the behavior of patients. Because, apparently, someone in the government decided that not enough of his patients were getting better according to whatever standard the government uses, they will not pay him for services rendered. Your patient died of terminal cancer? Fuck you, we're not paying you! Obese patient kept eating Krispy Kremes and got the sugar diabetes? Fuck you, we're not paying you! Despite those lurid and patently false examples, the basic premise remains: patients must improve according to government specifications or the doctor will not be paid for any services--all payments are suspended until such time as we deem suitable.
Actually, that isn't necessarily true. Yes, he won't get paid if he can't show that he counseled his patients on risky behavior, such as weight. And all that takes is one line in the reporting or even a check box. What is a problem, is the EMR's needs to be able to gather this data easily, and depending on the EMR, it may or may not.

And quite honestly, Pyrrho, have you ever seen his reporting? Or how he bills? Yes, the government is a pain in the ass at times, but so many doctor's from my experience are equally pain in the asses. They provide no reporting or little reporting and bill the highest code they can, and expect to be reimbursed for it.

I had one doctor's office who always billed the highest code possible, and when we met with him because he was complaining that his bills are always denied, we explained his reporting doesn't justify the codes billed, but he felt he should be paid at a higher rate even though he wasn't doing the work because he was special. And then you have the providers who just copy their previous notes, change the date and then add exactly one line or no lines. Or you have the providers who unbundle codes.

Or, my personal favorite, a anesthesiologist who billed constantly for inter-operative EEG, and were pissed because we wouldn't pay it because he was unbundling. Making sure his/her patient is appropriately anesthetized was the job, and the code of anesthesia during services paid not only for the code based on the procedure, but time as well, so they were not being paid small sums. Oh and what made this my favorite: Their 'justification' for being paid for the EEG? A photo copy of an artical from USA Today. Not a peer reviewed journal or any other legitimate source, but USA Today.
Pyrrho wrote:He believes that the government wants him to leave practice. He didn't, but he did sell his practice to an umbrella group and continues doing what he does under their auspices, which is working as a general practice physician caring for patients.

It's not unlike what's happening to teachers, who are required to file voluminous reports on student progress in addition to the mandatory tests. In Ohio, all this data goes to a private firm that applies an algorithm and issues a performance evaluation of the teacher, whose salary and career hang in the balance, even if they are teaching in the Cleveland urban schools where Johnny can't read because he can't be arsed to carry a fuckin' book, man, fuck this shit, school ain't for learning it for hangin' and smokin' up man, hey Boyce got some snow? Plus the grinding poverty and parents--usually just one parent, marriage being another thing of the past--who are in their own fucked up reality. Then there is the local government and the entrenched patronage system...

We are also given the opportunity to log on to WebMD and fill out a health assessment. Today it's voluntary, but HR has plainly said that eventually it will be mandatory.

A certain relative of mine was required, under her medical plan, to get a colonoscopy or be required to pay higher rates. She got the colonoscopy whether she needed one or not. Not that there is anything wrong with that...I should probably have one done myself, although I am so full of shit that it may take a year to clear the system.
Insurance companies do want to maximize their dollar, not just the government, and in order to to that, the need to make sure that the doctor does what he is supposed to do, and how are they to do that without sufficient reporting? Medical care is expensive. And there are preventative measures that people should be taking based on age and other factors that they don't. Health coaches can be great or they can be a pain, it is all in how they are applied.

I sincerely doubt the government wants him out of business, but they do want him to join modern times, and the tools are being provided, if he asks for them.

The fact of the matter is, our health care system in this country is severely broken. It sucks for all involved. Obamacare doesn't really fix much other than the pre-existing condition issue, but it is a foot in the door. We need better reform. We need medical care to be regulated, what can be charged regulated, and what is required. We need reasonable fee schedules that don't begger the doctor or the patient.

Oh and one final thought: The AMA is the one who develops CPT codes, which are what insurance companies,and yes the government, use to determine reimbursement. So Doctor's have a say in that as well. It isn't like they are blindly bumping along, and the insurance industry and government is out to screw them. I would say it is a too way screwing. Each seeing who can get their dick into the other first.
Chani

Pyrrho
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### Re: BOHICA, doctors!

I haven't looked at his books, no. I do know that he was almost in tears over this. He claims to have been working 80 hour weeks and going broke because of the lack of payment, that he couldn't pay his staff anymore, and sold the practice to a bigger group.

Sure, it's all anecdotal and I have no evidence. He's been a good doctor.
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Pyrrho
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### Re: BOHICA, doctors!

Hmm I just got an error:

General Error
SQL ERROR [ mysql4 ]

Can't create UNIX socket (12) [2001]

Sending to Pixy...
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### Re: BOHICA, doctors!

Pyrrho wrote:I haven't looked at his books, no. I do know that he was almost in tears over this. He claims to have been working 80 hour weeks and going broke because of the lack of payment, that he couldn't pay his staff anymore, and sold the practice to a bigger group.

Sure, it's all anecdotal and I have no evidence. He's been a good doctor.
I am not questioning whether he is a good doctor or not, nor how many hours he works. I am stating that there are tools out there for him to help him with these hurdles and if he has joined an umbrella practice, he needs to talk with the practice manager and find out what tools he could be using to make his life a lot easier. There are tools out there, but sadly people don't know about them, are reluctant to use them, or don't know how to use them, and in the case of EMRs are terrified by sticker shock. Medicaid and Medicare are not good at advertising what they offer.

I do feel for your doctor and his frustration as I felt for my former co-worker who was a wonderful woman who worked very hard, but was completely confounded by computers, and that made her work life more difficult. Times change, work processes change, regulations change. Think about your work: would you be successful if you used only the tools you had to complete your job that you had 10 years ago?
Chani

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### Re: BOHICA, doctors!

My GP brings a pc to the examination, and checks various boxes and/or types as we progress.

Ditto for a specialist who treats my wife; other specialists and her GP not that I've noticed.

Cloverlief
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### Re: BOHICA, doctors!

hammegk wrote:My GP brings a pc to the examination, and checks various boxes and/or types as we progress.

Ditto for a specialist who treats my wife; other specialists and her GP not that I've noticed.
A lot of doctor's offices have thin clients in the exam rooms. When I was working for Davita, every station had a thin client, but that wasn't really conducive to doing reporting, so one of the things I worked on was getting laptops and rolling carts for doing reporting while talking to the client. It is funny, the younger generation (in general) loved it, while the older people completely eschewed it. I had complaints from social workers that it came between them and their clients, and I asked, what is the difference between that and a pad of paper?
Chani

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### Re: BOHICA, doctors!

Cloverlief wrote:
Pyrrho wrote:I haven't looked at his books, no. I do know that he was almost in tears over this. He claims to have been working 80 hour weeks and going broke because of the lack of payment, that he couldn't pay his staff anymore, and sold the practice to a bigger group.

Sure, it's all anecdotal and I have no evidence. He's been a good doctor.
I am not questioning whether he is a good doctor or not, nor how many hours he works. I am stating that there are tools out there for him to help him with these hurdles and if he has joined an umbrella practice, he needs to talk with the practice manager and find out what tools he could be using to make his life a lot easier. There are tools out there, but sadly people don't know about them, are reluctant to use them, or don't know how to use them, and in the case of EMRs are terrified by sticker shock. Medicaid and Medicare are not good at advertising what they offer.

I do feel for your doctor and his frustration as I felt for my former co-worker who was a wonderful woman who worked very hard, but was completely confounded by computers, and that made her work life more difficult. Times change, work processes change, regulations change. Think about your work: would you be successful if you used only the tools you had to complete your job that you had 10 years ago?
Well...yeah. I'm still doing PowerPoint and that technology hasn't changed much in 10 years. My computer is faster. The Mac I use is from 2007. We have iPads but I use a 10-year-old program to build apps for it. One does what one must...

Anyway...yes, my doctor doesn't like computers. He does have a couple of people to do paperwork. The issues run a bit deeper than that, if I understood him correctly.
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### Re: BOHICA, doctors!

So are you still using Office 96 or did your company stop being cheap bastards and upgrade you to Office 2000?
Chani

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### Re: BOHICA, doctors!

hammegk wrote:My GP brings a pc to the examination, and checks various boxes and/or types as we progress.

Ditto for a specialist who treats my wife; other specialists and her GP not that I've noticed.
All the doctors I see regularly do that. Either laptops or tablets.
Yes, I do see many doctors. Fuck.
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