RE: [IP] reasonable?
I think you have an enviable situation with some great physicians.
Unfortunately not all physicians can take that luxury any longer.
A brief note to explain the ...(thank you very much medicare/medicaid)...
comment. Insurance companies will pay what they deem a service is worth. Say
for instance seeing a patient for a routine yearly checkup with appropriate
labs is billed at $100, as long as all insurance companies agree that $100 is
a "reasonable fee" then they all only pay $100 for the service. Where this
gets tricky is that "the government" (i.e. Medicare/Medicaid programs) feels
that $100 for the service will break their budget since they have so many
patients on their rolls, so they say "we will only pay $50 for the service,
take it or leave it." They do have collective bargaining on their side in
that they also guarantee that they will send (x) number of patients to the
provider. They also do arm twisting if you don't want to accept the lower
fees by threatening hospitals (who have to absorb the huge dent of non-paying
patients seen in their ER's) with not accrediting them to see
Medicare/Medicaid patients. As medicine has gotten better we have lived
longer. Those who get old enough will eventually be admitted to the hospital
for any number of conditions, and this is where hospitals actually make a
portion of the money back for what is pouring out the ER's doors. Oddly
enough if you want a piece of the ever increasing "old people admissions"
financial pie, you also have to guarantee the government you won't turn anyone
away at the ER for inability to pay. So essentially damned if you do, damned
if you don't. As the numbers and illnesses of the elderly continue to rise it
becomes a safer bet to accept the governments decreed prices. But then here
is the rub...no insurance company will pay more than their competitors! So
guess what every insurance company now will pay for the same service...you
guessed it...$50. So by playing ball with the government you essentially
screw yourself in terms of private insurance payments. These new proposed
"universal health plans" are expected to exercise more downward pressure on
prices for services since it will be one huge monolithic insurance (i.e.
government) program that would essentially dictate what a doctors time and
resources are worth. If you don't accept it you get no patients because the
government would control the whole population of patients. Don't be surprised
to see the number of applicants to medical school drop significantly as
medical reimbursement falls. There is no way to justify spending 12-15 years
in post high school education for an income that can't make up for the lost
time in which you only accrued debt during your education. My friends came
out of college and have been working the entire time I spent in undergrad,
medical school, residency, and fellowship training. They all have retirement
plans, stable incomes, a home, cars because of the ability to work slow and
steady and put something away for retirement as they went along. When a
physician finally finishes training, not only are they 200 to 300k in debt,
but they also have much less time to start saving for retirement. So for all
those who think that physicians will be happy to accept ever downward
spiraling reimbursements, think again. Ultimately you will get physicians who
have to see more and more patients per day just to maintain the semblance of a
hope of retirement. I wouldn't be suprised to see shifts from medical
education to more stable, sustainable, and shorter training time fields of
work. Smart people go to medical school, and I would venture to assume they
are often smart enough to do most of the other jobs out there that pay
Sorry everyone for the rant...
From: email @ redacted on behalf of R Leppanen
Sent: Sat 5/31/2008 1:28 AM
Subject: RE: [IP] reasonable?
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<<Also you have to keep in mind that with ever declining revenues for
each patient seen (thank you very much medicare/medicaid)>>
You also need to realize that where I am at, about 80% of the practicing
physicians DO NOT accept medicare or medicaid at all (absolutely none of
their practice is medicare or medicaid), and then the other 20% very very
few are acepting new patients.
Pretty much the only programmes that are accepting happen to be Residency
programmes, and some are not even doing that.
Where i am at, I would say 50% of the population with medicaid (not
medicare) are using the emergency room as their primary care due to very
little acceptance by doctors.
My own Internal medicine clinic as a example..
limits their medicare patient load to 20%
Limits their medicaid patient load to 3%
Thos with duel eligibility (medi/medi) are in that 3% catagory.
My own cardiologists office as another example...
Out of 5 endocrinology clinics in my area, only 2 accepts new patients with
either medicare or medicaid.
2 do not accpet NONE with medicare or medicaid (means 100% are either
private pay or private insurance).
1 is, and has been not accepting new medicare or medicaid patients for
Also out of our 3 "medical boutique practices", 1 DOES accept medicare AND
medicaid patients (although limits the amount to 10% of the clinic).
Otherwise they charge $7500 per year per patient. And they can see the
doctor when ever, talk to them on the phone when ever, email them when ever,
My pain clinic does accept new patients, and new patients with medicare and
medicaid, but in the state that I live in, there is OHP standard and then
OHP plus, and then there is 11 different HMO's and then there is the open
card version (no hmo, but more $$ out of pocket.. $3.00 to see a doctor, $2.
generic, $3 name brand, $25 for emergency, except for when admitted to
hospital from emergency then it is zero, vs if you have a HMO certain
medications are under the $2/3 formulary, but 99% are free, doctors are
covered, ect). Depending on your HMO, depends on which doctor you can see.
Some doctors will accept the "open" card and none of the HMO's and some will
not accept anything, but a particular OHP + HMO, and there is even less that
accept the standard card.
<<The only answer would be to pay cash out of pocket to one of
these medical boutique practices, and then the doctor can "afford" to
reserve the necessary amount of time for each patient>>
I can ring the doctor, and they will schedule a 15min slot for me, but if I
need more time than that, the doctor will stay with me and answer my
questions. I would say ALL my doctors do that. On Thursday, I had a 15min
appt with reg. doc. I got to sit and talk to my doctor for almost 30
minutes. Yesterday (Friday), I had a 4.30 appt with another doctor of mine
for a 15min appt. I did not walk out of her office until 5.40, which is 1
hour and 10 minutes. She did however, leave the room for her last patient,
and she was gone maybe 10 minutes before she came back.
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