Rep Retirement Lodge 201: A State You Don't Expect

[JF_Gophers]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Well, the bucket list is getting shorter. Just bought tickets for the 2020 Summer Olympics.

[leswp1]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Have not checked in here for some time but found your post. Welcome to medicine in the year 2019! never thought i would say this but very happy that we closed the office and went part time so many years ago when we saw the handwriting on the wall.

Yeah. Ran into someone at the market after I posted. Apparently this provider is nice pt pts but a beast to work for. Tons of turn over. Way too much experience with that. They are collecting 2 co-payments before you can get anything done. Hmmm. And I can't imagine what they are billing for that visit. It isn't a sick visit or a HM visit so I bet it goes to your deductible. Got in with someone we 'know'. Called the insurance member services and lit them up. Never thought I would do that. I hate when people complain but the total lack of concern for screwing me over and leaving me out to dry pi55ed me off. If they had at least apologized I would have felt better.

Well, the bucket list is getting shorter. Just bought tickets for the 2020 Summer Olympics.

Just a leeetle jealous!

[MarkEagleUSA]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good morning to tLodge!

[DrDemento]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Yeah. Ran into someone at the market after I posted. Apparently this provider is nice pt pts but a beast to work for. Tons of turn over. Way too much experience with that. They are collecting 2 co-payments before you can get anything done. Hmmm. And I can't imagine what they are billing for that visit. It isn't a sick visit or a HM visit so I bet it goes to your deductible. Got in with someone we 'know'. Called the insurance member services and lit them up. Never thought I would do that. I hate when people complain but the total lack of concern for screwing me over and leaving me out to dry pi55ed me off. If they had at least apologized I would have felt better.

Just a leeetle jealous!

Les-It took many years but the entire profession has been altered and i think permanently. When i first started most really cared about what they did and tried to do their best. Sure they wanted to get paid and certainly they were concerned about paying their bills and their overhead and earning a living. But that was not the entire reason for providing care. All the supervision, the control and the regulations imposed (by non medical people or by academic medical people who have never practiced in the real world) has now trickled down so that the really caring physicians and staff have either retired, cut back on practice or died. What you are seeing now is the effects of government and insurer provided services (I dare not even call it care). People in the field are no longer even called by their titles but instead are simple 'providers' and that is exactly how they have begun to see themselves and feel. In my 50 years of medicine I have simply refused to do that and I still try to be the same physician (note-not a provider) that I started out as. I can partially maintain that but only if I practice on a limited basis, provide the service i do gratis, and be thankful that Jenny and i have a life with so little overhead that we do not need to earn much of a living at this stage. you can wager that this will continue to get worse as 'providers' become the simple pawns and employees of both the government and the insurers.

[Swansong]

Re: Rep Retirement Lodge 201: A State You Don't Expect

I have a few doctors that I support that patients love but are absolutely impossible to work with or for. One in particular can never keep an MA for more than 9 months. MAs aren't paid particularly well and it's a pretty demanding job even working for a great doctor, so no surprise people are not lasting. On the bright side, the biggest problem user is leaving at the end of October

One thing to note - the term "provider" is used as a generic term in the same way "nurse" is at this point. I wouldn't take it personally. It's just a rough job category.

[Lady wore Black]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good Morning, Lodge!

Took the morning off as hubby and myself went to Iron Maiden at the Xcel Energy Center. Played the classics and it was a great time.

[Swansong]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good Morning, Lodge!

Took the morning off as hubby and myself went to Iron Maiden at the Xcel Energy Center. Played the classics and it was a great time.

I heard the setlist for this tour is incredible.

[Ralph Baer]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Hi Lodge!

[leswp1]

Re: Rep Retirement Lodge 201: A State You Don't Expect

I have a few doctors that I support that patients love but are absolutely impossible to work with or for. One in particular can never keep an MA for more than 9 months. MAs aren't paid particularly well and it's a pretty demanding job even working for a great doctor, so no surprise people are not lasting. On the bright side, the biggest problem user is leaving at the end of October

One thing to note - the term "provider" is used as a generic term in the same way "nurse" is at this point. I wouldn't take it personally. It's just a rough job category.

I call myself an NP. I refuse to be called a Physician Extender or a Mid-level. Both I find objectionable and a bad message to the patients as studies show we provide excellent care and NPs can practice independently. Provider is a generic term that I find least objectionable. I would say medical professional but that is too long.

In my experience Docs frequently have the attitude of a spoiled only child. This seems to come to the fore when their practice is successful and they have increasing demand because the patients love them. The success bloats their ego and no one is above them to give them a reality check. Not usually seen with people in small practice who are practicing for the love of doing it. THe ones trying to grow the business are the worst.

Les-It took many years but the entire profession has been altered and i think permanently. When i first started most really cared about what they did and tried to do their best. Sure they wanted to get paid and certainly they were concerned about paying their bills and their overhead and earning a living. But that was not the entire reason for providing care. All the supervision, the control and the regulations imposed (by non medical people or by academic medical people who have never practiced in the real world) has now trickled down so that the really caring physicians and staff have either retired, cut back on practice or died. What you are seeing now is the effects of government and insurer provided services (I dare not even call it care). People in the field are no longer even called by their titles but instead are simple 'providers' and that is exactly how they have begun to see themselves and feel. In my 50 years of medicine I have simply refused to do that and I still try to be the same physician (note-not a provider) that I started out as. I can partially maintain that but only if I practice on a limited basis, provide the service i do gratis, and be thankful that Jenny and i have a life with so little overhead that we do not need to earn much of a living at this stage. you can wager that this will continue to get worse as 'providers' become the simple pawns and employees of both the government and the insurers.

Absolutely agree with all of this!!
In our area there is no medical practicing left. Pretty much all of the 'old fashioned' people have been driven out by the PHO, hospital. They have changed the rules to make it untenable for them to survive. Stuff like ER Docs not allowed to admit, you need to physically see the pt and write orders before 4 hours. In the last 5 yrs I think almost all of the people in my age group practicing Primary care here have retired early or gotten out. All of my NP peers who started practice when I did have retired or are actively trying to, We are all below retirement age.

It is all Insurance and business. I quit because I refused to practice insurance and I refused to be forced to do unsafe things so I could 'capture' money they should have been paying to begin with (I was told I must write a new start anti-depressant for 90 days so the measure would be met- wonder who would have been responsible if the person became undepressed enough to ingest them all). The newer folk have no idea what Medicine should be or was. They are being taught to practice insurance. They structure things in a way that people who are motivated by the patient are penalized. They give the patient the message this is a service industry and we should make them happy. If all your patients are happy all the time you are a screw up.

[Swansong]

Re: Rep Retirement Lodge 201: A State You Don't Expect

There is a definite shift from "I am a care provider and this is my patient" - a philosophy of trusting some sort of learned expert - to "I am a patient and this is my care provider" - which I'm mixed on. Admittedly I'm new to the field and I'm definitely not a clinician, and while I think that encouraging doctor/diagnosis/medication shopping is a terrible thing, we also have the right to choose our own care, don't we?

The financial side of it is about the most confusing and opaque thing I've ever seen. I'd love to be able to price out procedures. I need a knee replacement? Let me choose my surgeon based on care, ability and cost. Sure, you can look up reviews of the surgeon and take references. But good luck looking up cost. If a hospital can even give you a procedure cost, it absolutely won't include all the other stuff that comes with it. Plus, the different cost scales based on negotiated insurance reimbursements. Or Medicare that pays 1/4 of the actual cost. Or self payers who get totally screwed.

[leswp1]

Re: Rep Retirement Lodge 201: A State You Don't Expect

There is a definite shift from "I am a care provider and this is my patient" - a philosophy of trusting some sort of learned expert - to "I am a patient and this is my care provider" - which I'm mixed on. Admittedly I'm new to the field and I'm definitely not a clinician, and while I think that encouraging doctor/diagnosis/medication shopping is a terrible thing, we also have the right to choose our own care, don't we?

The financial side of it is about the most confusing and opaque thing I've ever seen. I'd love to be able to price out procedures. I need a knee replacement? Let me choose my surgeon based on care, ability and cost. Sure, you can look up reviews of the surgeon and take references. But good luck looking up cost. If a hospital can even give you a procedure cost, it absolutely won't include all the other stuff that comes with it. Plus, the different cost scales based on negotiated insurance reimbursements. Or Medicare that pays 1/4 of the actual cost. Or self payers who get totally screwed.

This is true. I I think there is a difference between making informed choices for care and being able to shop for what you want like it is burger king. The patient should be an active participant and partner in making decisions but they aren't the managing partner. They don't have enough knowledge. We should not be a service industry where the client is always right and you have to make the client happy no matter what it takes. The insurance industry markets to the patient the nonsense about how they care and make sure the patient will get what they want and then they tell us we cannot consider what the patient really needs, only what the insurance company decrees is OK. The culture promotes the idea that this is an adversarial relationship that the medical person will be trying to screw the person out of what they are owed. They blame the Medical pro instead of the insurance that is actively working to provide as little care as possible to save $.

The financial side is a fiasco all around. The ACA was supposed to change that. They gutted that part of the bill and what they didn't gut the current admin is not enforcing. The insurance co are having a party.

You, as a pt, can't shop around for cost, find out what is covered, get a list of codes that will be covered by your plan. If you call to ask what the correct code is to get it reimbursed they refuse to give it to you because the Provider should know. (The provider can't find out the correct code when they call to ask either!) Some insurances arbitrarily decide that routine health maintenance tests/exams/procedures are not covered, even when they are standard of care. Or they only cover it at certain intervals that are not evidence based. They refuse to give a list or tell you they won't pay until after it is submitted. If you have ever had a diagnosis it cannot be on the slip or they can claim it is a diagnostic test and charge you. The minute a woman tells them she has a lump they charge her a diagnositic test and her 'free yrly mammo' is not covered. Most people don't know any of this. mr les just had a health maintenance procedure. It was billed by the Doc and the facility as Health Main. The anesthesia weasels billed him. I said this isn't right. He said it must be because of the deductible. I say no. He argues. I lose it and he calls to check. Sure enough it was not supposed to be billed to us. Don't you wonder how many of their patients are billed and pay blindly?

We can't get a comprehensive list of codes or what is covered easily. They make a habit of changing codes, procedures for submitting billing and what is covered all the time. It is like a massive shell game. Example- Billing for something simple like a Physical is not simple. To get the most reimbursement you need to separately code for the physical, the breast, prostate, gyn exam, each lab you did, the fingerstick, the performance of the fingerstick, each immunization, for the administration of the immunization, additional administration of anything past one immunization, certain other screening tests, interpretation of certain tests. They don't tell you any of this. If your billing people aren't good or well hooked in you can miss a ton of reimbursement. Then they get you again because they keep back the withhold claiming you didn't do any of the 'measures' because they weren't billed. No matter that they are clearly documented as having been performed. If you didn't code it right it didn't happen.

There are literally college programs with degrees for medical billing. Think about that.

[mookie1995]

Re: Rep Retirement Lodge 201: A State You Don't Expect

s'upp y'all

imagine going into restaurant and having to eat what the cook sent out, and not knowing how much you are to pay until the bill arrives in the mail after you poo

[MarkEagleUSA]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good morning to tLodge!

[Ralph Baer]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good Morning, MEUSA!


Good Morning to the rest of tLodge!

[JF_Gophers]

Just a leeetle jealous!

We are going at the beginning, so no track and field unfortunately. But the wife did pick Taekwondo, Tennis, and Beach Volleyball.

Only other event i would have wanted is swimming.