http://www.medrants.com/archives/5040 Contemplating medicine and the health care system Wed, 17 Mar 2010 23:16:37 +0000 http://wordpress.org/?v=2.9.2 hourly 1 http://www.medrants.com/archives/5040/comment-page-1#comment-530591 anonymous Sun, 29 Nov 2009 23:28:28 +0000 http://www.medrants.com/?p=5040#comment-530591 what happens to the extra patients when the hospitalist caps?   how were you able to negotiate this arrangement? what happens to the extra patients when the hospitalist caps?  
how were you able to negotiate this arrangement?

]]> http://www.medrants.com/archives/5040/comment-page-1#comment-530581 solo dr Sun, 29 Nov 2009 15:19:19 +0000 http://www.medrants.com/?p=5040#comment-530581 Ditto on FP schedule.    For 2010,  my patient range is 18-36 patients/day M-F and 15-25 on Sat from 7:40-1 PM.  Avg on weekdays is around 25 patients , which I  can see b y working 8-5.   I work  6 days a week in  the office with no day off,  so t hat  I can spend enough time with the patients and  keep up with the  paperwork.    I  enjoy seeing the patietns, but I am tired of the insurance companies and prior authorizations.  I have a 100% success rate on prior auths, yet  I have to spend 10-30 minutes  to prior auth an MRI or CT and provide radiology billing codes.  I have directly admitted patients from the office with appendicits and have  to argue with the insurance companies  for  the admission.  Every Jan. the medicare Part D prior  auths start all over, even  though 90% of my patients are on  generic meds. For 2010 the average copay is  projected  to be $30,  with the  range of $20-$50 per visit for  the primary care physician and a  massive check of $3-$35 from  the insurance company.  Visit averages in my area for a  level 3 outpatient equal $55.   The current system has no reward for working  hard.   The pay per performance for Medicare simply adds  more work to the schedule.  Private plans are trying to  find a way to link pay and performance. I  am solo,  so there is a one way negotion with  the insurance companies for fees.  The insurance companies  have not raised my fees in 3 years.  I look forward to Medicare, which at least gives me a 1-2%  raise and pays all  docors the same fee schedule in  my area.  I don't know why  our  profession, unlike accountants and lawyers, allow s free paperwork,  free phone calls, free availibitly  24/7 call, and no  extra pay  for holiday  work.   If  it were not for the joy of seeing my patients each day, I  would not stay  in this system.   No  other profession could survive with the demands placed on primary care physicians.  It is worthwhile when a  patient  thanks me for  going the extra mile or spending that extra 5-10 minutes  talking to the widow/widower   or depressed patient. Ditto on FP schedule.    For 2010,  my patient range is 18-36 patients/day M-F and 15-25 on Sat from 7:40-1 PM.  Avg on weekdays is around 25 patients , which I  can see b y working 8-5.   I work  6 days a week in  the office with no day off,  so t hat  I can spend enough time with the patients and  keep up with the  paperwork.   
I  enjoy seeing the patietns, but I am tired of the insurance companies and prior authorizations.  I have a 100% success rate on prior auths, yet  I have to spend 10-30 minutes  to prior auth an MRI or CT and provide radiology billing codes.  I have directly admitted patients from the office with appendicits and have  to argue with the insurance companies  for  the admission.  Every Jan. the medicare Part D prior  auths start all over, even  though 90% of my patients are on  generic meds.
For 2010 the average copay is  projected  to be $30,  with the  range of $20-$50 per visit for  the primary care physician and a  massive check of $3-$35 from  the insurance company.  Visit averages in my area for a  level 3 outpatient equal $55.  
The current system has no reward for working  hard.   The pay per performance for Medicare simply adds  more work to the schedule.  Private plans are trying to  find a way to link pay and performance.
I  am solo,  so there is a one way negotion with  the insurance companies for fees.  The insurance companies  have not raised my fees in 3 years.  I look forward to Medicare, which at least gives me a 1-2%  raise and pays all  docors the same fee schedule in  my area.  I don't know why  our  profession, unlike accountants and lawyers, allow s free paperwork,  free phone calls, free availibitly  24/7 call, and no  extra pay  for holiday  work.  
If  it were not for the joy of seeing my patients each day, I  would not stay  in this system.   No  other profession could survive with the demands placed on primary care physicians.  It is worthwhile when a  patient  thanks me for  going the extra mile or spending that extra 5-10 minutes  talking to the widow/widower   or depressed patient.

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