[...] is self-explanatory. Remembrance A rant dedicated to a patient who died on our service. Levels of thinking My attempt to explain the nuances of medical decision making, usi [...]

This is interesting stuff. As a layman, I am in no position to distinguish between levels one and seven – I go to the doctor, and do what he tells me to do (except for that bit about weight loss ). I want a great doctor, but probably don’t need one 90% of the time.

But, at the GP or FP level, I wind up making the decision about who to go to, even though I have no real basis.

“even more puzzling is why doc’s put up with this”

Hey, you got a solution? I’m all ears.

simple care received press on national bradcast networks and CNN about three months ago. this is where I learned of cash only practices.

it is not perfect.. but as costs of operating the business are so drastically reduced, doc’s actually earn more/hour.

other solutions exist..boutique medicine,
certain low risk endeavors,
or as med school admissions data indicates ..do something else.

OT Post of the day:

FDA supressed study showing that teens on anti-depressants were more likely to commit suicide.

habla ingles Bernie?

The BMJ article did not say that the teenagers were “more likely to commit suicide”.

“Suicide-related event” is not the same as “suicide”.

i might be very wrong on this point, so at risk of sounding foolish…I think the lead off rant by Db makes an argument that physicians really are not “given” enough time (by way of poor rewards) to think carefully about what we do. Mr Simon points out that we can do things differently. Naturopathy does seem absurd, but so does submitting a 99213 office code, receiving 57 dollars for that service while the costs to provide that service is 52 dollars.

Naturopaths, trial lawyers, plumbers, electricians….don’t labor under these conditions…so why should we?

above comments do describe the
“perfect storm” scenario

good medicine requires careful thoughtful action.

current health insurance schemes do not reimburse health care providers enough to “allow” for careful thinking. (hence this new rant thread)

skeptics loudly proclaim that
physicians are too blame.

employers don’t hire due to rising health care premiums.

trial and defense lawyers make a very good income just sitting on the sidelines watching this dysfunction continue, “cases” just plop on to their laps.

access to care is diminishing.

sound like physicians would do better to walk away from this whole mess and start anew.

very comforting to see doc’s
regaining control:

Joint Economic Committee of Congress
Testimony of

Robert S. Berry, M.D.
President & CEO of PATMOS EmergiClinic, Inc.
Greeneville, TN

April 28, 2004

Good morning. Thank you for inviting me to speak with you today.

My name is Dr. Robert Berry. I graduated from the University of North Carolina Medical School in 1989 and did my residency in Primary Care Internal Medicine at the University of Alabama Hospitals in Birmingham. I became board certified in Internal Medicine in 1992, scoring at the 99th percentile on the exam’s “core component” – a measure of competency in General Internal Medicine. Up until I started this clinic over three years ago, I practiced Internal Medicine for six months and Emergency Medicine for the balance. I became boarded in Emergency Medicine in 2003.

I represent a growing movement in cash only practices and the patients who use them. Yet our clinic is a little different in that we center medical services around the unique needs of the uninsured. They are the most cost effective healthcare consumers, and we all could learn something for them.

you can click
http://www.aapsonline.org and search the left column for the link entitled:
AAPS testifies before congress on cash based practices

also here is the ugly reality of a survey a few yeatrs ago….” shows that the average cost to a physician office to process a Medicare claim is more than $24, amounting to about $60,000 in annual costs to the average office. A 2003 survey revealed that physicians and their staff spend almost one-fourth (22%) of all of their time devoted to Medicare paperwork and compliance. Some of the other findings may also explain the movement to cash-based practices”

sounds like more than a few doc’s are re-doing their practices to allow time with patients.

another head shaker is seen in the huge and costly industry of medical billing.

As billing has become so complex there are thousands of consulting firms available at 30-50 dollars/hour to help doc’s navigate wasteful billing schemes demanded by insurance companies.
while we should be spending all our time in mastering medicine…we in fact spend a lot of our professional time listening and implementing the commands of these billing consultants.

our local medical society (out of necessity )reccommends that we frequently spend several hours/year attending expensive workshop seminars regarding coding/billing issues. (in order to keep our offices solvent)

again…to admit that we need more time to spend on clinical issues and less time on billing issues threatens the medical billing indusstry as well

to think that some doc’s don’t need expensive billing software licenses, consultants, billers, auditors and expensive “work flow” consultants is too radical.

too think that doctors are simplyfying their offices and going to cash only and as a result being allowed to spend more time wth patients is heresy to those who depend on our current wasteful sysytem.

http://www.simplecare.com

Dr. Berry’s Website, as I mentioned. He’s been the center article in the Wall Street Journal, he’s testified before Congress, incredible when you really think about it.

His “radical” idea is to provide primary care on a cash basis. Costs are lower, so he can charge lower, more affordable fees. For a REALLY radical concept, he posts them, so you know what you are spending.

For that, he gets the attention of the United States Congress.

Anyway, he may have more insight or direct you to other places.

thanks, i find this very interesting and does make sense. I do question , however, in the age of “you’ll be hearing from my lawyer” that cash paying patients will try to avoid expensive imaging ( MRI, CT scan’s. etc..) in order to save money. As you know this does lead the physician open to a failure to diagnose suit.

any thoughts on this.?

sorry to wander off the original rant..but it seems if we make changes on how we practice and do spend more time with patients (via cash environment) and avoid the aldactone mishpap’s..we might later open ourselves to legal issues if we defer expensive work-ups (due to a patients ability to pay) we might regrets the cash only office.

i agree liability risk will not be worse than traditional setting.

I do use a standard form and after explaining to patients why I reccommend a test such as c-scope …if they refuse they sign the form. I do tell patients this is to cover my but. they sign readily.

I sense that cash paying patients will realize occasionally expensive tests will be suggessted and they are in the driver’s seat if the physician informs @ risks/benefits.

Recently National Public radio did a segment stating that the number of employers offering health insurance dropped a large amount in 2003.
I know of 4 cash only practices in our town of 100,000. they are busy and I foresee more demand for these practices as then rsanks of uninsured grow (now @ 44 million folks).